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CITY OF ORONO � APPLICATION FOR UTILITY PERMITS <br /> Box 66 (1335 So Brown Rd) - � SEWER WATER <br /> Crystal Bay, MN 55323 T i� ��/� <br /> *********************************************************************�***** <br /> I:-You mai y apply�tor 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. P�its are nat vali�d until yo�i reoeive a ��*�+;t c�rd. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connection pPxmits may be issued to licensed oontractors only. <br /> 6. Contact the Public Works Department (473-7357) for utility stub as-built locations. <br /> DO NOT EXCAVATE IlJ ANY STREE,T AI�ID DO N(yr TAP ANY MAIN without express approval of the <br /> Public Works Departznent. Issuance of a pezmit 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 mtioe r�quired. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: �/S S s�d��G/�U� �� - <br /> Occupancy Type: Residential �G Commercial <br /> OWNER'S NAML: ,S�J/T/-< ��� �yf�//�� Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S N�: o� �i? '�G�3�'� �� • sus. Phone: y�9�/9'�� <br /> Mailing Address: ���� �� /P ��G City:�'1,¢P�F�liAj,-i> Zip: � <br /> **tk**iFit**ir*�r*****�ciF'�FiF***iFittk**�Ftk**�F�1r***ir�lr�k****�k*ic�k***�kic�Fic**iciF�k*�k�t***�t*�ttkir�Y* <br /> _ - P$RMIT TYPE AND FEE CALCQLATION <br /> MIINICIPAL SEWER CONNECTION ($30. 00 per stub) $ 3�� � <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 copper; other <br /> WATER METERS must be picked up and paid for at City Hall. <br /> (5/8" meters = $133. 00; 3/4" meters = $181. 00; 1" meters = $235. 00) <br /> Water meters must be set and 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 /> 1. Subtotal of above permit requested $ <br /> 2. State Surcharge .50 <br /> The State Building Code Division Surcharge of .50 per permit must be <br /> included for each well, sewer and water connection permit requested. <br /> 3. Postage � Handling (Only mail-in applications) $ 1. 50 <br /> 4. TOTAL PERIKIT 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 co�lete, true and correct. <br /> Signature of Applicant: L%l/ � Date: /� �� �4a <br />