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. . '�«'�'��.o-a#J 1,_ <br /> ' CITY OF ORONO APPLICATION FOR UTILITY PERMITS ° ���`'*- <br /> ��' � ' Box 66 (2750 Kelley Parkway) SEWER/WATER � ��� � ,', <br /> � . �. s� � <br /> Crystal Bay, MN 55323 ���� `` � �� <br /> } <br /> �l� < <br /> �`��� <br /> GENERAL INFORMATION ' a,� ' <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. Permit cards will be sent by `'' �' �� <br /> return mail the same day the application is received. "''. <br /> a �' <br /> 3. Permits are not valid until you receive a permit card. ,. ; ' � - <br /> 4. Wark 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 � a � <br /> IN ANY STREET AND DO NOT TAP ANY MAIN without express 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 State Code requirements. � �� �•� <br /> 8. All work must be inspected before it is covered. Ca11473-7357. ' r* '``` _. �� � x: <br /> 24 hour notice required. � �� � <br /> 1 <br /> ,�/J/� ,— �/�'--- ,�� ��; <br /> JOBSITEADDRESS: • � ---�✓� `-� i�� ,.,? <br /> Occupancy Type: � Resid ial Commercial � �' <br /> �� <br /> Owner's Name: -� 2t1��-� PhoneNumber: �` ���.� <br /> Mailing Address: City:_ 7ip: " �`r�: <br /> Contractor's Name. �-� ' PhoneNumbe��$'`� - �.s% S,� '. `�j� <br /> �xr�, <br /> �� � L-.� � y CI (...�-P �.J 3�� �� <br /> _ Mailing Address: �LS` � h'� � ZP� �, <br /> � F �`s. <br /> { �� <br /> PERMIT TYPE '�� <br /> Municipal Sewer Connection ($35.00 per stub) $ ��� <br /> pipe size � " inches; material(��.'..� PV on sand fill); cast iron ;4 Y1� �� <br /> SAC Charge($900.00)must accompany all sewer permit applications unless prepaid. If not prepaid, � wr �".: <br /> a sewer connection permit will not be issued. �a_� � <br /> t�_ � �: <br /> Municipal Water onnection ($35.00 per stub) �,�� $ � y < � <br /> �' p i p e s i z e � i n c h e s; m a t e r i a l_�c o p p_e r,'� o t h e r _ ,.�, <br />�;'. WATER METERS must be picked up and paid for at�i=ty Hall. �` �i <br /> (5/8" meters = $139.00; 3/4" meters= $191.00; 1" meters= $247.00) �- ' <br /> Separate Plumbing Permit issued for water meter. �..`';�i��,� <br /> Water meters must be set and sealed by Orono Water Department(473-7357)upon completion ;;�`,, �,� <br /> of ineter installation. �'� � �''� <br /> REQUIRED minimum setbacks from drainfield and septic tanks= 75' � �� <br /> ` � _ <br /> r;, REQUIRED setback from sewer line=20' ' '' � <br /> � � <br /> ,_��.� <br />�,. - , . �e.'_' l Y <br />�. <br /> PERMIT FEE CALCULATION ` ` '�` �'= <br />'`� 1. Subtotal of above permit requested � � � � $ d �� '� $� <br />;i'�, 2. State Surchar�e $ .50 � �� , <br /> fi ' The State Building Code Division Surcharge of$.50 per permit must be f �x;r r � <br /> r included for each well,sewer and water connection ermit re uested. '��� $ <br /> P 9 � : _ <br />���� 3. Postag„g& Handling (Only mail-in applications) $ 1.50 ° � �� <br />��-� 4. TOTAL PERMIT FEE(add lines 1-3 above) $ ��� �,� <br /> �'. f <br /> j`�n <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do a '� � ,� <br /> all work in strict accordance with the ordinances of the City and the regulations of the State of �r' M�;, <br /> Minnesota, and certifies that all statements made on this applicatic�are complete, true and correct. °:-= "� <br /> :�;' ��` <br /> �•,. <br />_� , ° <br /> � ;� Z.��� ��.—� ; �x <br /> ; Signature of Applic � Date: ' <br /> , °� ti:� <br />�:'� _� <br />