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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> ,� , li�� 66 (2750 Kelley Parkway) SEWER/WATER � �� <br /> Crystal Bay, MN 55323 �a ?' <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fees shown below. Permit cards will be sent <br /> by return mail the same day the application is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> �. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(249-4600)for utility stub as-built locations. DO NOT EXCAVATE <br /> IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works <br /> Deparhnent. Issuance of a permit does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Ca11249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: ���.� � �'Y'Y'r"l � <br /> Occupancy Type: Residential Commercial <br /> O�vner's Name: Phone Number: <br /> Mailing Address: City: 7�p: <br /> Contractor's Name: ���.- , ��a /r.� �Y,�--�t�'Phone Number:�/1 >/ j -%�f� / <br /> � �� 7� <br /> NTailing Address: 7/ Z�i 7/�-,�.a,� �—e"/ City:.1��`�t Zip: � ,, � <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ -�-,`� ° z' <br /> pipe size inches; material Schedule 40 air tested; cast iron <br /> SAC Charge (2000 rate $1,100.00) must accompany all sewer permit applications unless prepaid. <br /> If not prepaid, a sewer connection permit will not be issued. <br /> l�7unicipal Water Connection ($35.00 per stub) $ �`S " `' <br /> pipe size inches; material copper; other <br /> W'ATER METERS must be picked up and paid for at City Hall. <br /> `Vater meters must be set and sealed by Orono Water Department(249-4600)upon completion <br /> of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks= 75' <br /> REQUIRED setback from sewer line=20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ 7 � �� � <br /> 2. State Surcharge $ .50 <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each well,sewer and water connection permit requested. <br /> 3. Posta�e & Handlin� (Only mail-in applications) $ - -�� <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ �� J� �' <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete,true and correct. <br /> Signature of Applicant: -'�.'�G�v�- � Date: /( � �^ � C'/ <br />