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CITY OF ORONO APPLICATION FOR UTILITY PERMZTS <br /> Box 66 (1335 So Brown Rd) SEWER WATER <br /> Crystal Bay, MN 55323 � �� <br /> **********************************************************************�**** <br /> I:-'You mai y�apply�tor utility perndts 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 /> PeYmit 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 pezmit aard. <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 Depart�nt (473-7357) for utility stub as-built locations. <br /> DO NOT F,XCAVATE IN ANY S'IREE,'T AND DO NOT TAP ANY MAIN without express approval of the <br /> Public Works Department Issuanoe of a permit does not grant this approval. <br /> 7. A1 1 work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is oovered. Call 473-7357. <br /> 24 ho�a notive r�,i r��3_ <br /> **************************************�************************************ <br /> JOB SITE ADDRESS: �-S ���' `s���w� �'� <br /> Occupancy Type: /� Residential Commercial <br /> OWNER'S NAME: -�-�i��-� r✓��,��z�=��; Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S N�1�: LCi.��i-���'�' 1�ri�_ <br /> Bus . Phone: ��'G /�y�� <br /> Mailing Address: ,�� . �,� �i � City: 5;�,�;�,�1 Zi ,.5�,.5_3�� <br /> ******************************�r***********************************P******** <br /> ^� P$RMIT TYPE AND FEE CALCIILATION <br /> MIINICIPAL SEWSR CONNECTION ($30.00 per stub) $ <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 completion of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> REQUIRED setback f rom 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 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 /> *************************************************************************** <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 complete, true and correct <br /> �� <br /> Signature of Applicant: � � Q� Date: �.S � � - �/"� - <br /> .t�b� <br /> � <br />