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CITY OF ORONO 6124730510 09/29/97 13:5915 :02/02 NO:030 <br /> U'I'V OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66(2750 Kelley Parkway) SEWEWWATER <br /> Crystal Bay, MN 55.323 <br /> fa fiNE AL 1jSFD& ATlQ�t , <br /> I. You may apply fot utility permits by mail or in person at the City offices, <br /> 2. Mailed in applicatiaos aro 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 /> 3. Permlts are not valid until you receive a permit card. <br /> 4. Work must not begin unless the permit caret is available on the job site. <br /> 3. Utility connection permits may be issued to licensed contractors only, <br /> 6. Contact the Public Works Department(473-7337)for utility stub as-built locations. DO NOT l;XCAVATF. <br /> IN ANY STUET 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 insponed before it is covered. Call 473-7357. <br /> 24 hour notice required. <br /> JOB$ITEADDRI,SS: <br /> Occupancy Type: Residential Commercial <br /> Owner's Naive: o n. " Phone Nutri A ((OR <br /> Mania Address: t C ` City:e Zip: 65-5 <br /> Contractor's Name: w n i Aa Phone Numbe — <br /> Malliag Address:(17 City: - �J <br /> PERMIT TYPE <br /> Municipal Sewer Connection($35.00 per stub) $ <br /> size ( ) <br /> pipe 't.t._inches; material PVC ori sand fill); cast iron <br /> - <br /> SAC Charge($900,00)must accompany all sewer permit applications unless prepaid, If not prepaid, <br /> a sewer cotinection petmit will not be issued. <br /> Municipal Water Connection ($35.00 per stub) $ <br /> pipe size__,L__inches; material �(_copper; other <br /> WATER METERS must be picked up and paid for at City Hall. <br /> (5/8"meters-$139.00; 3/4" meters $191.00; 1"meters=$247.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Witter Department(473-7357)upon completion <br /> of teeter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks=75' <br /> UQUIRED setback from sewer line a 20' <br /> &RMIJ FEf;.CA4CULA330N <br /> I, Subtotal of above permit requested <br /> 2, S_ ate Surchgra $�o <br /> The State Building Code Division Surcharge of S.50 per permit roust be <br /> included for each well,sewer and water connection permit requested, <br /> 3. P'95149C AHadIjU((hely mail-in applications) $ 1 SO <br /> 4. TOTAL PERMIT FEE(add lines 1-3 above) $ <br /> The undersigned hereby applies to the City of Otono 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 that all statements made on this application etre complete,true and correct. <br /> Signature of Applican . ! Daher <br />