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%_i t Y mr umt)Nu APPLICATION FOR IJTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWERIWATER <br /> Crystal Bay, MN 55323 <br /> I. 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 foes shown below. Permit cards will be sent by <br /> return mail the sante day the application is received. <br /> 3. Permits are not valid until you receive it 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(473-7337)fa"utility stub aF-built locations. DU NOT.EXCAVATE. <br /> IN ANY STREEFT AND DU NOT TAP ANY MAIN without express approval of the Public Works <br /> Department. Issuance of a permit does not grant this approval. <br /> 7. Atl work must be done in accordance with State Code requirements. <br /> 8. All work trust be.inspected before it is covered. Call 473-7357. <br /> 24 hour notice required. <br /> J0BSI1'F:ADDRESS: SSS 'T \-�, -. <br /> Occupancy Type: X Residential Commercial <br /> Owner's Name:_ i , f i�vr-zS' Phone Number: <br /> Mailing Address: City: Zip: <br /> Contractor's Name: 1-1 Phone Number, 7&3 riC/(F, % �Y <br /> Mailing Address: o City: L �Zkr5 3" <br /> URNIT TYPL <br /> Municipal Sewer Connection 135.00 per stub) 0 $ <br /> pipe size A__ inches; matena)S(.t\4 PVC (on sand fill); bast iron <br /> SAC Charge($900,00)must accompany till sewer permit applications unless prepaid. If not prepaid, <br /> a sewer connection permit will not be issued. <br /> Municipal Water Connection ($35.00 per stub) $ <br /> pipe size _ inches; material copper; other _ <br /> WA"1"ER MITERS must be picked up and paid for at City]"Tall. <br /> (518" meters - $139.00; 3/4" meters-$191.00; 1" meters=$247.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water tneters must be set And sealed by Orono Water Department(473-7357)upon completion <br /> of meter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks=75' <br /> REQUIRED setback from sewer line n 20' <br /> PERMIT FEL G.,_ALCULATION <br /> 1, Subtotal of above permit requested $ <br /> 2, Sttste.Such roe $i _50 <br /> The State$ul1d4 Code Division Surcharge of S.SO per permit must be <br /> included for each well,sewer and water connection permit requested. <br /> 3. los aYg&Hudling(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 /> E41 work in strict accordance with the ordinances of the City and the regulations of the State of <br /> N innesota, and certifies that all statements made on this application are complete, true and correct. <br /> Signature of Applicant:_ <br />