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CITY OF ORONO `'�r % APPLICATION FOR UTILITY PERMITS <br /> f � Box 66 (1335 So Brown Rd) y - " SEWER WATER <br /> ,; j� Crystal Bay, MN 55323 <br /> `� ************************************************************�************** <br /> I: You ma�pply�or 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. ' <br /> Permit cards will be sent by return mail the same day the application is received. <br /> 3. P�ennits are nat valid tmtil you reoeive a pP.a�it card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connection permits ma.y 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 STREET AND DO NCYr TAP ANY MAIN without express approval of the <br /> Public Works Depaztment. 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 �nspected before it is covered. Call 473-7357. <br /> 24 ha�r notioe required. <br /> **************************************�*********�************************** <br /> JOB SITE ADDRESS: 7�!' /U y�/C��{�v�e�t-'�� j7/�-,��'� <br /> Occupancy Type: x Residential Commercial <br /> OWNER'S NAME: �,v-1�/ �z��=ri-���-���f�� Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAML: C���LL=� C-�1la/� Bus. Phone: �7 3/ 3 i��3 <br /> Mailing Address: /�p� w�:�.�-� /��ait�v City: /����i3c1,�y Zip: �iz - <br /> *************************************************************************** <br /> ---� P$It1�IIT TYPE AND F$E CALCIII.ATION <br /> MIINICIPAL SEWER 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 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 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 certif.�es that all statements made on this <br /> application are co�lete, true d correct. <br /> Si nature of A licant: V�'�";"; -� Date: � Gf �/�,�j <br /> s rr 1 � <br />