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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> . Bax 66 (1335 So Brown Rd) SEWER WATER <br /> ' Cry5tal Bay, MN 55323 <br /> / *************************************************************************** <br /> , . ou ma�y�apply�or 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. <br /> Permit cards will be sent by return mail the same day the application is received. <br /> 3. Pe�its are nat valid imt,il you reae.ive a pe�.it �ard. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Dep�artment (473-7357) for utility stub as-built locations. <br /> Dp NOT F,XCAVATE IN ANY STRFET ADID DO NOT TAP ANY MFIIIJ without express approval of the <br /> Public Works Depaztm�nt. 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. Call 473-7357. <br /> 24 haur natioe requirea. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: �I�( J �q,.,IGy [�Q-Q�� l'�C <br /> Occupancy Type: ` � esidenti 1 Commercial <br /> OWNER'S NAI�: Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAML- �-,Q-)�v a �i J�([r,,,,:��-` Bus. Phone: Ll 7 y �"�77� <br /> Mailing Address: " ' City: �;�sccLf���;. Zip: � � � ' <br /> ******************* *** ******* ***************************************** <br /> �. P$RMIT TYPE AND F$E CALCIII,ATION <br /> MIINICIPAL SEWER CONNECTION ($30. 00 per stub) $ <br /> pipe size inches ; material PVC (on sand fill ) ; cast iron <br /> SAC Charge ( $700.00) must accompany all sewer permit applications unless <br /> prepaid . If not prepaid, a sewer connection permit will not be issued. <br /> MIINICIPAL WATER CONNECTION ( $30. 00 per stub) $ <br /> pipe size inches; material c�opper; other <br /> ' c u an .�� F�� �� City Hall. <br /> (5/8" meters = $133. 00;� 3 4" 'm t s � $181. 00� 1" meters = $235. 00) <br /> Water meters must be set an sealed by Orono Water Department (473-7357) <br /> upon campletion of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20 ' <br /> **************************************************************************� <br /> l. Subtotal of above permit requested $ <br /> 2. State Surcharge .50 <br /> The State Building Code Division Surcharge of .50 per permit must e <br /> included for each well, sewer and water connection permit requested. <br /> 3 . Postage � Handling (Only mail-in applications) $ 1. 50 <br /> 4. TOTAL P$RMIT FEE (add lines 1-3 above) $ <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, <br /> agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this <br /> application are complete, true d�orrect. <br /> � � — �' � <br /> � <br /> Signature of Applicant: Date: <br />