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. � �. <br /> (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 pernuts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee sho�vn below. Pernut cards will be sent by retum mail the same day <br /> the application is received. <br /> 3. Permits are not valid until��ou 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 Departnient(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without e�press approval of the Public Works Deparhnent. Issuance of a pemut does not grant this approval. <br /> 7. All work nuist Ue done in accordance with State Code requirements. <br /> S. All�vork must be inspected before it is covered. Call(952)249-4600, 24 hour notice required. <br /> JOB SITE ADDRESS: /�fl� 5'��%e ��,�� ��• <br /> Occupancy Type: � Residential Commercial <br /> Owner's Name: J�`�l,q.-C (3 v�.�..=� Phone Number: ��� ' �$�- 3717 <br /> Mailing Address: �-,-,,,,e- City: �1 S Zip: �-s�'y�'t- <br /> Conh•actor's Name: C�en��s c�ra'f-s- r .a�..:_-�-�— Phone Numbe►-: <br /> Mailing Address: Y 3 �� ( ti.,.�R�{ i��- �, City: �.�(� Zip: <br /> PERMIT TYPE ❑ Comlections �Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,350.00) $ (Set Rate) <br /> Sac Charge inust accompan.y all sewer pennit applications unless prepaid. <br /> (If not preplid, a sewer connection will not be issued) <br /> Municipal Sewer Connection/Disconnec epa' ($35.00 per stub) $ <br /> pipe size y" inches; material - Schd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect/Repair ($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 /> Water mete�-s 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 tanlcs =75' <br /> REQUIRED setback from sewer liiie=20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above pennit requested $ <br /> 2. State SurcharQe $ .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 & Handlin� (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 gulations of the State of Minnesota, and certifies that all statements <br /> made on this application are complete, t arid ect. <br /> Signature of Applicant � `�� Date: � Z�?- � � <br />