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Doc-04-2001 12:44pr Frcrr-CITY OF ORONO +0522404616 T-217 P.001/001 F-305 �jI_ <br /> kuptinu u`rtbryMp <br /> t� 1 `5 <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITSP6' 174� <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 ilk 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 rec+sived. <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 (95?-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 /> Warks Department. Issuance of a permit does not grant this approval. <br /> 7, All work must be done in accordance with Stale Code requirements. <br /> 8. Al work must be inspected before it is covere+l. Call(952)249-4600. <br /> 24 hour notice regaired. <br /> JOB SITE ADDRESS: 6i 79 s rl CS` ck <br /> Ocoupan 'TYpe; Residential __-- Commercial <br /> Owner's Name: .j rey-- -n = rr i-- Phone Number: <br /> Mailing Address: City: tip: <br /> Contractor's Na ne: iTloi N.fx Y:, `7"-I (-1.;-)p Phone Number:9r-c -93-5-'/'7/'7 <br /> Mailing Address:/.!-1 /�Ltd Viri,,. "► 4 . City: <br /> PERMIT TYPE t`�Ci,,�< c- <br /> Municipal Sewers ($35.00 per stub) <br /> Ver pipe size inches; material Schedule 40 air tested; cast iron <br /> s-'17' SAC Charge (2000 rate$1,150.00)must accompany all sewer permit applications unless prepaid. <br /> Loi c If not prepaid,a sewer connection permit will:lot be iissued. <br /> Municipal Water Conntetien($35.00 per stub) c`'' • $ <br /> pipe size inches; material_ 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 /> REQUIRRD minimum setbarks from drain field and septic tanks=75' <br /> REQUIRE) setback from sewer line=20' <br /> PERIYHTFEE_CALCULATION <br /> ]. Subtotal of above permit requested $ '70.C;() <br /> 2. State Surcharge $ . .50 <br /> The State Building Code Division Surcharge o S.50 per permit must be <br /> included for each well,sewer and water conne<lion permit requested. <br /> 3. Postage&Bandling(Only mail-in applications) $ s_ <br /> 4. TOTAL PERMIT FEE(add lines 1-3 above) $ '7©. :Lb <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:�l ar f2-yr KF Daft.1 -• �, <br /> � .t f <br />