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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 /> 1. You mayaapply 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. <br /> Permit cards will be sent by 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 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 EXCAVATE IN ANY STREET` AND DO NOT TAP ANY MAIN without express approval of the <br /> Public Works 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. Call 473-7357. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: sO <br /> Occupancy Type: Residential Commercial <br /> OWNER'S NAME: %Z_W_1C y Phone No. : <br /> Mailing Address : �, v Tc � y City: CD -,e0 ® <br /> CONTRACTOR'S NAME: 11'1�11_12z G,/ /9_4L14_ Bus . Phone: <br /> Mailing Address: Sa-cD �/Z/41 /��� City: C.l�✓�L a Zips 3� <br /> *************************************************************************** <br /> 3S'.CPERMIT TYPE AND FEE CALCULATION <br /> MUNICIPAL SEWER CONNECTION ( - per stub) $ _3 `� <br /> pipe size /'inches ; material ' (:' .-' PVC 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 /> MUNICIPAL WATER CONNECTION ( $3-B:UU 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 meter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75 ' <br /> REQUIRED setback from sewer line = 201 <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) $ 3 6- . 6 <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 complete, true d erect. <br /> Signature of Applican Date: '1 , / <br />