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Ju1-02-2003 10:44am From-CITY OF ORONO +9522494616 T-752 P.002/003 F-T22 <br /> CITY OF ORONO APPLICATION FOR UTILITY PERNIITS <br /> Boz 66(2750 Kelley Parkway) SEWEIt/WATER <br /> Crysta7 Bay,MN 55323 <br /> t <br /> cEx�RaI.INFo�TTO�i � <br /> 1. You may apply for utiliry perinits by mail or in peison at the Ciry offices. <br /> 2. Mailed ia applications arc:subje�.K to the postage and handling fee shown below. Permit cards will be sent by return mail the same da� <br /> the applicarion is received. <br /> 3. Permits are not valid until you receive a permit eard. <br /> 4. Work must not begin uniess the permit card is available on tha job site. • <br /> 5. Utility connection permi��raay be issued to licensed contractors only. <br /> 6. Contact the Public Wo�iss Department(952-249�600)for utiliry stub as-built locations. DO NOT EXCAVATE 1N ANY ST1tEET ANL <br /> DO NOT TAP ANY MA1N without express approval of the Public Works Deparnnen� 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 ruust be inspected before it u covered. Call(952)249-4600. <br /> � 24 hoar notice required. <br /> J4B SYTE ADDRESS: 3770 � o��iJe. � d�/'� /'e, �'�4�jon <br /> Occupancy Type: Residential Comraercial <br /> Owner's Narae:_��Q�i' nv Phone Number: <br /> Mailing Address: � City: Zip= <br /> Contractor's Name: � Phone Nnmber: g.��_9913'��- <br /> Mailing Address:/47 IV ,� 4 City: Zip: <br /> PERIVIIT TYPE <br /> Municipal Sewer Connection($35.00 per stub) $ -��- �� <br /> pipe size�inch�;s; material/e�L Schedule 40 air tested; cast iron <br /> SAC Charge(2002 rate$1,200.00)must accompany all sewer pernut applications unless prepaitl. If not prepaid,a sewe <br /> connection permit will not ba issued. � <br /> Municipal W�ter Connection($35.00 per stub) �Z� $ ��-. d D <br /> pipe size8 w Z'`inches; material�copper; other, L�1 l° <br /> WATER MET'ERS must be�picked up and paid for at City Hall. <br /> Water meters must be set a.nd sealed by Orono 'W�ter Department (952-249-4600) upon completion of inete <br /> instatlation. <br /> gEQUiRED mini.mum setbacks from drain field and septic tanks=75' <br /> REQUIRED setback from sewer]ine=20' � <br /> PFRNIIT FEE CALCULATYON <br /> 1. Subtotal of above permit requested $ �� • �� <br /> 2. State Surehar�e $ .50 <br /> The State Building Code Division Surcharge of$.SO per permit must be <br /> included for each well,sewor and water connecdon permit requested. <br /> 3. Posta�e&Handlin�(Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FI'sE(add lines 1-3 above) $1�5_ 5� <br /> The undersigaed hereby applies to the G�ry of Orono for issuance of a Utiliry Permit, agrees to do all work in stri� <br /> accordance with the ordinan.ces of the City and the regulations of the State of Minnesota,and certifies that all statemen <br /> made on this application are comp e,true and t. <br /> .. . <br /> Signature of Applic ► Date: a <br />