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(Undated 2/12/01) <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 /> 1. 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 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 (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. All work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: --Z-0d0 W c6&fr-G4/4s ,C,/ <br /> Occupancy Type: > Residential Commercial <br /> Owner's Name: B)// Phone Number: 9 c Z`417h-/Og. <br /> Mailing Address: Z.,j,f-, U,'./, ,—//;//s City:01'',7k, U Zip: <br /> Contractor's Name: Sy_;/ir� StrLic« Phone Number: -4/77-4%300 <br /> Mailing Address: 3GGO Cd,R/t% City:Uidy4 Zip: 3----f,11 <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ <br /> pipe size L/ inches; material y Schedule 40 air tested; cast iron <br /> SAC Charge (2000 rate$1,150.00)must accompany all sewer permit applications unless prepaid. <br /> If not prepaid, a sewer connection permit will not be issued. <br /> Municipal Water Connection ($35.00 per stub) $ <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 set 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 /> REQUIRED setback from sewer line=20' <br /> PERMIT FEE CALCULATION <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) $ <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: 41:77V,� Date: 'Z / <br /> r <br />