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CI`PY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (1335 So Brown Rd) SEWER WATER <br /> Crystal Bay, MN 55323 f ' �� C� � <br /> *************************************************************************** <br /> I�'You maIny`�pply�or utility pernu.ts 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 /> Pern�it cards will be sent by return mail the same day the application is received. <br /> 3. Pe�.its are mt va]id iuYtil you reoeive a �*�;t c�rd. <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. <br /> DO NOT F�CAVATE IN ANY S'IRE�r At�ID DO NOT TAP ANY MAIN without express approval of the <br /> Public Works Departsnent. 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. Call 473-7357. <br /> 24 hour no�tioe requirea. <br /> *************************************************************************** <br /> JOB SITB ADDRSSS: _� � � V �--- <br /> Occupancy Type: Resi tial Commercia'2 <br /> OWNER'S NAI�: ��',��C � �� �.��� � Phone No. : � <br /> Mailing Address: City: � � <br /> �� � <br /> CONTRACTOR'S NAME: � Bus . Phone: ��ty � <br /> Mailing Address: � , City: ip: �'� / <br /> ********************** ** ***********�******************************* * *** <br /> �. P$'I2MIT TYPE AND FSE CALCIILATION <br /> MIINICIPAI� 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 f or 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 f rom 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 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 PERIKIT FBE (add lines 1-3 above) $ <br /> ****************************�t********************************************** <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 Minneso , d certifies that 11 statements made on this <br /> application are co�lete, true an rre <br /> Signature of Applica Date: r�� ,/y ��--- <br /> �. <br />