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�! <br /> � CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> r <br /> ; Box 66 (2750 Kelley Parkway) SEWER/WATER �0 <br /> Crystal Bay,MN 5�323 °� <br /> D <br /> � GEI�TERAL 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 /> ;. 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 /> 5. 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. Call 249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: Z � �C� // �,��-�-�'L 1�'z <br /> Occupancy Type: _ � Residential Commercial <br /> Owner's Name: C; �� " -c� � Phone Number: 9s7- Lf �3- �9%� <br /> i�lailing Address: G �. � City: /�� , Zip: <br /> Contractor's Name: ti� /��,. ���/'-�-� Phone Num er: 7�,� L�;� S'(�� <br /> Nlailing Address:�/7 n y'/�-t���z �1�f City��- ,-,-C Zip: S--S-37�� <br /> PERNIIT TYPE <br /> i�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 /> �Tunicipal `Vater Connection ($35.00 per stub) $ <br /> pipe size inches; material copper; other <br /> WATER 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 /> PERIVIIT FEE CALCULATION . <br /> 1. Subtotal of above permit requested $ <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 /> 3. Posta�e & Handlin� (Only mail-in applications) $ 1.50 <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 <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 conect. <br /> /� <br /> Signature of Applicant: �� -��-L Date: ,���� "J�� <br /> � I� <br />