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Doc-04-2001 12:44pm Fram-CITY OF ORONO +pg2Z464616 T-297 P.001/001 F-306 <br /> EU�c1�tO�!F/t4N1J <br /> CITY OF ORONO A.PPL��ATION FQR LTTILITY PE�tMTTS <br /> r �Box 66(2750 I{alley Parkway) SEWEIt/WATER <br /> Crystal Say,MN 55323 <br /> GENE1tA�iNFORMATYON <br /> 1, Yau may spply for utility permits by rnail or u►person at the City a�ces. <br /> 2, Mailed ia applications are subject to the postage and handlit�fee shown below. Perrnet ce�rds will be sent by <br /> return mni!th�same rlay the appli�ation is rec�;ived. <br /> 3, Permits are nat vAlid until yon raceive a pe►mit card. <br /> 4, �Vork must not begin unless the pernut eard is available an the job site. <br /> S. Citiliry connectian permits may be issued to licensed contrsictors only. <br /> 6, ContAck the Public Works Departmeat (45?-249-4b00} for utiliry stub as-bailt locations. pQ NQT <br /> EXCAYA'I'E IN ANY STREET ANA D�NC�T TAP ANY MAIN without express approval of the Public <br /> Wttt�Dtpsrtment. Issuance of a permit doss not giant thIs apptnval. <br /> 7. AEl w�rk must be done in accor@snca with Sta�e Code recuirem�ats. <br /> , 8. AA work meLst be inspe,ctect bEPore it is covere�1, CaII(952)249-4600. <br /> 24 haur natice reqaired. <br /> .ra�s�r�nz�ss:r�� 9 sh o�.,Q;�.,,.� ��e..;v�� <br /> C3c�upan�y'i'yp�: '>( R�►sideniiai QCommerciai <br /> �.D � Phone Numb�: <br /> 4Wuer's NBt�u�� 1y e..�.1 lC� r-�L o . <br /> Mailiu��Addresa �k�� Sln�,�c- '� �✓ City:C�c-cx�o 7�r: � <br /> Contractor'a Natp�e: �1 Pbanc Number:._9S."t-°►�'�-��1� <br /> Mailing Address:I City:�R'�+tin.�,-�Y-�Lo�7�p: S��S <br /> P�RMYT TYP`F <br /> � Muni�ipal Sewer Connectian ($35.Oa per stub) $ �5, ar�____. __ <br /> 1,�r�� pipe size '�- _inches; material,,,��Sch�dule 40 e.ir tested; cast iron <br /> �""'�' SAC Charge (200Q rate$1,150.a0}must acconzpan�a]1 sewer p�scr�it applications unless prepaid. <br /> �� r If not prepaid,a sevver conn�atian permit will�wt be issued. <br /> Munteipal'VYAter Con tion($35. par stub) $ <br /> pipe siu inc s; m erial �copper; o <br /> WATER METERS must bc p' ked p and pai�t for at City 1 <br /> Water meter� must bc sct an aied by (lrono Water artmcnt (952-?.49-d600) upon <br /> compledon of inettr Last�llati . <br /> RE(�UT�D minim setb from drain d and septic =7S' <br /> REQC�rRE'D setbae �om sewcr e=2 <br /> PFBl���'�F�F�LbTi41Y <br /> l. 3ubtota;of abovc��it:�qw�stcd * 3 S� Plt�„� <br /> 2. State Surc�tc $ .SO <br /> 'Ibe 5tata Buiiding Codc Divisinn Surcharga oi'S.SO per permit must be <br /> includad for each wali,sewer and water conncc tion permit rcqu�stccl. <br /> 3. �asta_ge&�a.ndli��(Qrily mail-in app]ications) $__ �� _. <br /> 4. TQTAL PERMIT FEE(add linas 1-3 above) $ 3S. SZ� <br /> Tbe undersigned hereby applies to#he City of t�rona for issuance af a Utility P�rmit, agrces to do <br /> all work in sCiet �ecorciu'ice with thc ordinarn.es of the City and the regulations of th� Stat� of <br /> Muincsata,and certifies that all statememts ma�le on this�applicxtion are eamplete,true and correct. <br /> Signature of Applican�iGl�/!'LOI. �,�GP/1'�.rn Dafie: � -o -d <br />