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'O►sc-04-2001 12:44pm From-CITY OF ORONO +05224134616 1-217 P.001/001 F-305 <br /> tVpull meu 41LhlU1) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66(2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay,MN 55323 <br /> GENERAL INFORMATION <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 fee shown below. Permit cards will be sent by <br /> return mail the same day the application is recaived. <br /> 3. Permits arc 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 (952-249-4600) for utility stub as-built locations. DO NOT <br /> EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public <br /> Works Department. Issuance of a permit does not grant this approval. <br /> 7. AU work must be done in accordance with Stu a Code requirements. <br /> 5. AR work must be inspected before it is covered. Call(952)249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: (-9)f1 <br /> Occupancy Type: X. Residential Commercial <br /> Owner's Name -- -1 .' Phone Number: <br /> Mailing Address: \ • City:( r, tip: <br /> Contractor's Nath . , C.. Phone Number: ci °133-'7'717 <br /> Mailing Address: -e 1 •Y .s: ) City: <br /> PERMIT TYPE <br /> Municipal Sewer Connection($35.00 per stub) $ <br /> Ver 1_ pipe size inches; material.. Schedule 40 air tested; cast iron <br /> SAC Charge (2000 rate$1,150.00)must accompany all sewer permit applications unless prepaid. <br /> V.)1 A If not prepaid,a sewer connection permit will not be issued. <br /> aQu Municipal Water Connection($35.00 per stub) $ .56 Chc <br /> pipe size I inches; material k copper; other <br /> WATER METERS must be picked up and paid for at City Hall. <br /> Water meters must be act and sealed by Orono Water Department (952-249-4600) upon <br /> completion of meter installation. • <br /> REQUIRED minimum setbacks from drain field and septic tanks=75' <br /> REQUIRE])setback from sewer line=20' <br /> PEIMI i 'EE CALCULATION <br /> I. Subtotal of above permit requested $.1.c.1 •aM <br /> 2. • . State Surcharge $ . .50 <br /> The State Building Codc Division Surcharge oi'$.50 per permit must be- <br /> included for each well,sewer and water conne<tion permit requested. <br /> 3. Postage&_Handling(Only mail-in applications) 1.50• ti • <br /> 4. 'TOTAL PERMIT FEE(add lines 1-3 above) $ 'l 0 <br /> The undersigned hereby applies to the City of Orono 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 are complete,true and correct. <br /> Signature of Applicant�,'2-)-1et c (a- o Date: 9- <br />