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, (Updated 1/5/04) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pernvts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee sho�m below. Pernut cards will be sent by return mail the same day <br /> the application is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the pemut card is available on the job site. <br /> 5. Utility coiuiection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility shib as-built locations. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a pemut does not grant this approval. <br /> 7. All work nuist be done in accordance with State Code requiremeuts. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600,24 hour notice required. <br /> JOB SITE ADDRESS: ���1' ����9c� �--%G�� ���-%��� <br /> , <br /> Occupancy Type: �f,/Residential Commercial <br /> Owner's Name: ��� ��, �',=/E�- - Phone Number: <br /> Mailing Address: City: Zip: <br /> Co�rt�•actoi-'s Name: �,�/.ry � ��r�'%�I/G�,>,���',G'�Plione Number: �-SS-�- - .�o G—? <br /> Maili�g Add►•ess: �"yS��� .���/,S— City;�?���/� ��«Zip: -s-s�-s f <br /> PERMIT TYPE � Connections ❑Repairs ❑Disco�lnect (Check One) <br /> SAC Cl�arge (2003 rate $1,350.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer pennit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Connection/Disconnect/Repair ($35.00 per stub) $ <br /> pipe size�inches; material Schd 40 air tested; cast iron <br /> Municipal Water C��nection/Disconnect/Repair ($35.00 per stub) $ <br /> pipe size�inches; material copper; �11er <br /> WATER METERS nn►st be picked up and paid for at City Hall. <br /> Wate►• meters must be set and sealed by Orono Water Department <br /> (952-249-4600) upon completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks = 75' <br /> REQUIRED setback from sewer line =20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above pennit requested $ <br /> 2. State Surchar�e $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per pernut must be <br /> included for each well, sewer and water connection pernut requested. <br /> 3. Postage &Handling (Only mail-in applications) $ 1.50 (Mail In Only) <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict <br /> accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements <br /> made on this application are complete, true and correct. <br /> Signature of Applicant:__ �� �a�r--�����-. Date: �2%'� —.�'�� <br />