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� ' <br /> x �, <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER �� y 3 �� <br /> Crystal Bay, MN 55323 � <br /> G <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 postaje 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 Deparhnent(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 /> Department. 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 /> (�G24 hour notice required. <br /> c� <br /> JOB SITE ADDRESS: � l C� D r �- ��-�—� <br /> Occupancy Type: � Residential Commercial <br /> O�vner's Name: �ic-� -.�•-�- Phone Number: <br /> �Iailing Address. 2/G G' �� City: � - Zip: S�9 <br /> Contractor's Name: vr�,. ��,N.� Phone Number:7� � � 77 5��f� <br /> Nlailing Address: �/y o �/_�.,-.L.��-- City: Zip:_5��73 <br /> PERNIIT TYPE o <br /> �Iunicipal Sewer Connection ($35.00 per stub) $����- <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 /> 1lunicipal Water Connection ($35.00 per stub) $ <br /> pipe size inches; material copper; other <br /> `VATER 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�nd septic tanks= 75' <br /> REQUIRED setback from sewer line =20' <br /> PERMIT FEE CALCULATION � � <br /> 1. Subtotal of above permit requested $ ��- a � <br /> 2. State Surchar�e $ .50 <br /> The State Building Code Division Surchar�e of$.50 per permit must be <br /> included for each well,sewer and water connection permit requested. <br /> ;. PostaQe & Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ 3��c' <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do <br /> all ���ork in strict accordance with the ordinances of the City and the regulations of the State of <br /> ��linnesota, and certifies that all statements made on this application aze complete,true and correct. <br /> �, <br /> Signature of Applicant:��./���.��- ��- Date: � — f� -C'/ <br /> �► � I <br />