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CITY OF ORONO � APPLICATION FOR UTILITY PERMITS <br /> Box 66 (1335 So Brown Rd) � � ��_ ` SEWER WATER <br /> Crystal Bay, MN 55323 <br /> *************************************************************************** <br /> . ou ma�ly�tor 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 sam�e day the application is received. <br /> 3. P�i.ts are mt valid until y�au reoeive a �*�+�;t card. <br /> 4. Work �ust not begin unless the permit card is available on the job site. <br /> 5. Utility oonnection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Dep�nt (473-7357) for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY SZR�r A1�ID DO NCyr TAP ANY MAIN without express approval of the <br /> Public Works Department. Issuanoe 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. Call 473-7357. <br /> 24 haur mtiae requirec3. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: /� �-� l � �GL,��IZ� G�� ��ti� <br /> Occupancy Type: � Residential Commercial <br /> �_ � ��l/ vYY�-�J►�' L%O <br /> OWNER'S N�: Phone No. : ���-����'� <br /> Mailing Address: City: <br /> CONTRACTOR'S NAME: ��2 2�vJ �� - Bus. Phone: !77 =�S��l�" <br /> Mailing Address: City: Zip: <br /> *************************************************************************** <br /> _ __.. PERMIT TYPE AND FE$ CALCIILATION <br /> MIINICIPAL S CONNECTION ( $30.00 p� 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 /> AiIINICIPAL WATER CONNECTION ($30.00 p� 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 campletion of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75 ' <br /> REQUIRED setback from sewer line = 20 ' <br /> *************************************************************************** <br /> 1. 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 c�lete, true d rr <br /> Signature of Applicant: Date: l� -5'� �/�'"— <br />