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�� CITY Or ORONO APPLICATION FOR UTILITY PERMITS <br /> Box G6 (2750 Kelley Parkway) S�WER/WATEIZ <br /> � Cryst�l Bay, MN 55323 <br /> GfNf;RAL INFORMATION <br /> l. You may apply for utility permits by mail or in person at the City offices. <br /> 2, Mailed in applications are subject to the postage and handling fees shown below. Permit cards will be sent by <br /> return mail the same day the application 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 permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(473-7357)for utility stub as-built locations. DO NOT EXCAVATE <br /> IN ANY STREET AND DO NOT TAP ANY MAIN wit}�out expcess approval of the Public Works <br /> Department. Issuance of a permit does not grant this approval. <br /> 7. All work must be done in accordance with Stnte Code requirements. <br /> 8. All work must be inspected before it is covered. Call 473-7357. <br /> 24 hour uotice required. <br /> JOBSITEADDRESS: � ��v `Z�d'zr�;S <br /> Occupancy Type: ,, � Res' ti�l Commerci:tl � <br /> Owner's Name:.�u— � `��,�r� Phone Number: <br /> M�iling Address: City: 7�p: <br /> Contractor's Name. c� � „ Phone Number: 6�S"� ^ �-S�'Q <br /> Mailing Address: '7��S �u�` G-� �� City:�/�l �/-��- 7�p:S'�'-��� <br /> PERMIT TYP� <br /> Municipal Sewer Connectioii ($35.00 per stub) $ <br /> pipe size Lf;, inches; material>D� �'l� PVC (on sand fill); cast iron <br /> SAC Charge($850.00)must accompany all sewer permit applications unless prepaid. If not prepaid, <br /> a sewer connection permit will not be issued. <br /> Municipal Watcr Connection ($35.00 per stub) $ <br /> pipe size '[ r inches; material copper; odier <br /> WATER MrTERS must be picked up and paid for at City Hall. <br /> (5/8" meters = $139.00; 3/4" meters=$191.00; 1" meters= $247.00) <br /> Separate Plumbing Permit issued for water meter. <br /> WRtcr mctcrs must be set�nd sealed by Orono Watcr Department(473-7357)upon complction <br /> of mctcr installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks= 75' <br /> REQUIRCD setback from sewer line= 20' <br /> P�RMIT rCI; CALCULATION <br /> 1. Subtotal of above pernlit requested $ <br /> 2. State Surchar�e $ .50 <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each weli,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 /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and correct. <br /> L ' r- <br /> Si =nature of A 1' �'�L�� � Date: <br /> b PP <br />