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�D�c-04-2001 12:44pm From-CITY OF ORONO +1622404616 T-2oT P.001/001 F-305 <br /> �U�7YatR1 frltidUlJ <br /> CITY OF ORONO APPL[CATION FQR UTI�TY PERMTfS <br /> Box 66(2754 KcUey Perkway) S�WEIt/WATER <br /> Cry9ta!�siy,MN SS3Z3 <br /> GENERAL INFdRMATYGN <br /> 1. Yaa msy appty for utilhy pamip by rnsll ar i��person at the City of�icas. <br /> 2, MaUad la�pplications ere aubjoct w tfia postage snd handling fee shown below. Pexmit ca�ds wilt be semt by <br /> return mail iha same day the apptic�tion is rec�slved. <br /> 3. Permib art aot v�tfd uatil yan raoofva a peemit card. <br /> 4. Wak must not be�in unlesa the perrait aerd 1a avsllsblo an ehe job aite. <br /> S. Ut�ltty connection permite may be issued to licensed mnuactors only. <br /> 6, Coatact the Public Works �eat (95?-?�t9,4600) for ut�ity �tub as-bvilt lacations. DQ NQT <br /> @CCAYATE IN ANY STtLEET AND DO NC�T TAP ANY MAJN w�ithout express approval of tha Public <br /> Waics Depertmeni. tssuauce of a permlt doas not�ant thls approval. <br /> 7. All wark must be done in accord�ce with Skue Code raquiroiaoats. <br /> , 8. AA wodc must be inspoexed befo�e it is covere�l. C�lI(9S2)7�49-4400. <br /> 24 hour aotice raqdred. <br /> .roa srr�,�n��s�: 1�l 4� ��o�cl�.�,�L � _ _ <br /> ,�"r,r� <br /> O�auPwu�''Iy'Pe: �R�idmtisl�� � Commercial <br /> Ovra�r'�N�nt: ,�� — Phone N�bee: <br /> Ma�ua��dr��:.l l��� Jr�, �,g� cit�: � .r�� Ss � <br /> Contractor'aNa��: r�� P6oacNumbe�:�1�,°t3a-'��1� <br /> Mstilfn�Addre=:: City:��__o� 2tp:��� <br /> ,G�.�c�� P��'Y'7'YF� <br /> �` �.i,� Mua�tdpal Sewer Conncction(�35.OU per etub) $ � <br /> 11� pipe size incl�s: matcrial �Sehe�ul�44�ir tasted; cast iron <br /> +"""'� SAC Charge(240Q rate$1.150.00)must�tccoaupacry all sewqr permit applic;ations unless pnepaid. <br /> �j ! If uot Pre�mid,a saw�er connectlon permit wiA�wt be issuad. <br /> r ���:'G�iuntcipal'NVs�ter Connection{�35.00 per stub) $ <br /> �-�s pipe size inches; matcrial copper; other <br /> WATER METE.R.S must bc picla�d up aud pai�l for at City Hall. <br /> W�ter mebers mast be sct xa� sealed by (Irano Water Department (952-?,49-4600) apoa <br /> compledon oi rneter lastxllatlon. <br /> REQ[JIIt�minuaunt satbacics from dra.ia field and septic tanks=75' <br /> REQCJIlt�setback$om sawer lin�=z0' <br /> P�'����,��ALCULATION <br /> 1. 9ubtotal of above pcnuit requcstad $ <br /> �. sc��.s��� � .so <br /> 'I7�a stete auitding Code 1'�ivis�nn Surct�ge o,•$.SO per pamic must ba <br /> inalvded for eaoh weB,sewer and water conaa 3;on pamit rrquastad. <br /> 3. postage&�analrng(Grily mail in applications> �� l.sa <br /> 4. TQTAL PERMIT FEE(�dd linos 1-3 abo�e} $ <br /> Tbe uadersi�ned her�by spplies to thc Ciry af t�roc�o for issuancx af a Utility Perniit,agrccs to do <br /> ell wark itl 9ttiQt �OCOrdllttlCe With the ord+'nan., � of the C�ty end the regulatious of the Stste of <br /> Miiincsota.and certifias that all statameuts mada on this'appllcation are eomplete,true and carrect. <br /> Signature of Applic�l� ��p� Date: ��"0� <br /> -�����c�c.c��.� -��. ex�s-� SZ.we,Y � ��-,,,� C� <br /> ��� ��� � <br /> � <br />