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. -. � <br /> (Updated 1/5/04) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pernuts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will be sent by return mail the same day <br /> the application is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the pernut card is available on the job site. <br /> 5. Utility comiection pernuts may be issued to licensed contractors only. <br /> 6. Contact tl�e Public Works Deparnnent(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN AN1'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 work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600,24 hour notice required. <br /> JOB SITE ADDRESS: �I G� L��� � ✓� ./� <br /> Occupancy Type: Reside tial Commercial <br /> Owner's Name: � /Ztr�t� (,(�p��� �a,��S Phone Number: `�5 z y 7 3 db�� 2- <br /> Mailing Add►•ess: 2 t ao �-tk � �7 . City: �;,,1,;�� Zip: S5 3 5� <br /> Contractor's Name: �p Lv �- e- Phone Number: `71a � �r�� ,,s�7 <br /> Mailing Address: o �, � /�� . „.i City: 1� � Zip: S� ��s�� <br /> PERMIT TYPE ,�Connections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,350.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer �onnection/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 <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 /> REQUIRED setback from sewer line=20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per pernut must be <br /> included for each well,sewer and water connection pernut requested. <br /> 3. Postage & Handling(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 with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements <br /> made on this application are omplete, true and correct. <br /> / <br /> Signature of Applicant: >�c� � '��-�---�— Date: �- Z -7`�`� <br />