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CITY OF ORONO APPLICATION FOR DTILITY PERMITS <br /> � Box 66 (1335 So Brown Rd) SEWER WATER O <br /> ' Crystal Bay, MN 55323 3�S <br /> *************************************************************************** <br /> I:--You mai yt Fply�or utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject �to �tY�e postage and handling fees shown below. <br /> Permit cards will be sent by return mail the same day the application is received. <br /> 3. Pe=mits are nat valid imtil you reoeive a pe�it card. <br /> 4. Work must not begin unless the permit card is available on tY:e job site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Departme.nt (473-7357) for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY SZREET AND DO NOT TAP ANY MAIN without express approval of the <br /> Public Works Department. 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. Ca 11 473-7357. <br /> 24 haur notiae requiY�ed. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: 3 Y I(� S�v f���+��-j 1//�� <br /> Occupancy Type: �_Residential Commercial <br /> OWNER'S NAME: `�y�-��' ��;;�� ��l �'�c��� � Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAME: X=C�v�'�1 � �='�� �-�-�`��� Bus. Phone: f�-�- � � <br /> P: -, c/ <br /> Mailing Address: ���/ C'o � I J City: vYfe��, h Zi �' <br /> *************************************************************************** <br /> PERMIT TYPE AND FEB CALCIILATION <br /> MIINICIPAL SEWER CONNECTION ( $30 . 00 per stub) $ <br /> pipe size � inches ; material �C PVC (on sand fill) ; cast iron <br /> SAC Charge ($650.00 ) must accompany all sewer permit applications unless <br /> prepaid. If not prepaid, a sewer connection permit will not be issued. <br /> MIINICIPAL WAT$R CONNECTION ( $30 . 00 _per stub) $ <br /> pipe size �inches ; material �� copper; other <br /> WATER METERS- must be picked up and paid for at City Ha . <br /> (5/8" meters = $125 . 00 ; 3/4" meters = $163 . 00 ; 1" meters = $218 . 00 ) <br /> Water meters must be set and sealed by Orono Water Department (473-7357) <br /> upon completion of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> RE�UIRED setback from sewer line = 20 ' <br /> *************************************************************************** <br /> l. Subtotal of above permit requested $ <br /> 2. State Surcharge . 50 <br /> The State Building Code Division Surcharge of .50 per permit must e <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 a 11 work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and cer �f�s that all statements made on this <br /> application are c�lete, true and correct.� <br /> �-, <br /> Signature of Applicant: � Date: 7-�� - �� � <br />