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i � <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay,MN 55323 <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 postage 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 /> 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. Ca11249-4600. <br /> 24 hour notic required. <br /> JOB SITE ADDRESS: � 0 � /�`��_-� � <br /> Occupancy Type: Reside ia Commercial <br /> Owner's Name: � � � �!'! Phone Number: �f 7� - � ? %� <br /> Mailing Address: City:���n--L Zip: <br /> Contractor's Name: � Phone Numb ��� --�'�%S' <br /> Mailing Address: ��G' City:��_�����- 7iP: ����7S� <br /> PERMIT TYPE --- <br /> Municipal Sewer Connection ($35.00 per stub) $ �'�7 �� <br /> pipe size�_inches; material��G Schedule 40 air tested; cast iron <br /> SAC Charge (2000 rate $1,100.00) must accompany all sewer pertnit applications unless prepaid. <br /> If not prepaid, a sewer connection permit will not be issued. <br /> Municipal Water 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 /> Water 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 /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surcharee $ .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 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 correct. <br /> Signature of Applicant:��,��-o�� ��.�� Date: � `v�� _ dfl <br />