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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> �' Box 66 (2750 Kelley Parkway) SEWER/WATER � <br /> Crystal Bay, MN 55323 > S. S � ��� <br /> • �Z <br /> GENERAL INFORMATION <br /> 1. 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. Pernut 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 pernut card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Warks Departrnent(249-4600)for utility stub as-built locations. DO NOT EXCAVATE <br /> IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works <br /> Departrnent. 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 inspected before it is covered. Ca11249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: � � �� � ` , � � <br /> �,1. G� C�t'l�U `? � CJ <br /> Occupancy Type: "' Residential Commercial <br /> Owner's Name: �Z� C� � s�� N � Phone Number: <br /> Mailing Address: City: 7ap: <br /> Contractor's Name: �' t� 5 `��-'�� Phone N ber: '-� 1 � L3 1c� <br /> Mailing Address:_� � ��, �� �{�� � .-, � �.- City: � Ln � 7�p: �5 3 � <br /> PERMIT TYPE 2 � <br /> Municipal Sewer Connection ($35.00 per stub) /' $ � <br /> pipe size � inches; material �� Schedule 40 air tested; cast iron <br /> SAC Charge ($1,050.00) must accompany all sewer permit applications unless prepaid. If not <br /> prepaid, a sewer connection permit will not be issued. � <br /> Municipal Water Connection ($35.00 per stub) $ <br /> pipe size�_inches; material � copper; other - <br /> WATER METERS must be picked up and paid for at City Ha1L <br /> (5/8" meters= $130.00; 3/4" meters= $180.00; 1" meters= $240.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department(249-4600) upon completion <br /> of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks= 75' <br /> REQUIItED setback from sewer line=20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .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. Posta�e& 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 t t all statements made on this application are complete, true and correct. <br /> ` � U � �l �% <br /> Signature of Applic Date: <br />