Laserfiche WebLink
(Updated 1/5/04) � <br /> CITY OF�RONO APPLICATION FOR UTILITY PERMITS \ <br /> Box�6 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay, MN 55323 <br /> GENER�L INFORMATION <br /> 1. You may apply for utility pernuts by mail or in person at the City offices. <br /> 2. �Iailed in applicarions are subject to the postage and handling fee shown below. Pernut cards will be sent by return mail the same day <br /> the applicarion 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 pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a pernut does not grant this approval. <br /> 7. All w•ork must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is co�-ered. Call(952)249-4600,24 hour notice required. <br /> JOB SITE ADDRESS: �O� �(.iorelr1✓�� 1�/�. <br /> � <br /> Occupancy Type: Residential _� Commercial <br /> Owner's Name: 5 �� ,�—.,J�s n�J' /�f�1 �n�tl) Phone Number:�`��� �(7�- y 7� <br /> Mailing Address: City: Zip: <br /> Contractor's Name: e �G Phone Number �.� - �/ <br /> Mailing Address: �p � City: t2vou��� Zip:_sS-365� <br /> PERi'�IIT TYPE �Connections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,350.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer pernut applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Connection/Disconnect/Repair ($35.00 per stub) $ <br /> pipe size�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 ��h'!P �ro,� <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 <br /> (952-249-4600) upon completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks = 75' <br /> REQUIlZED setback from sewer line=20' <br /> PERI�IIT FEE CALCULATION <br /> l. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 (Minimum) <br /> The State Building Code Division Surcharse of$.50 per permit must be <br /> included for each well,sewer and water connection pernut requested. <br /> 3. Postaae & 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�vith the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements <br /> made on this application are complete, true and rr <br /> c <br /> Signature of Applicant: Date: O � <br />