Laserfiche WebLink
(Updated 5/3/02) <br /> ONO APPLICATION FOR UTILITY PERMITS <br /> Bo Kelley Parkway) SEWER/WATER& SAC AO(e3/4-7-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 return mail the same day <br /> 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 EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public 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)249-4600,24 hour notice required. <br /> JOB SITE ADDRESS: 00( (A..) CBeete ed. <br /> Occupancy Type: >( Residential Commercial <br /> Owner's Name: V?!cNA{LD PuLre-- Phone Number: <br /> Mailing Address: (s livegFacc. Rds City: )Rom Zip: .5-1-"/ <br /> Contractor's Name: 47 ( f,?7n.i-r, v�c2 Phone Number: 95-,9 -4/73-7�y7 <br /> Mailing Address: __.? .0 Co. /a. /Dl City: `/t,Nau:7oNk4o Zip: ,S-S-3 <br /> PERMIT TYPE ®Connections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2002 rate $1,200.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Cgnnection/Disconnect/Repair($35.00 per stub) $ <br /> pipe size /151 inches; material Schd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect/Repair ($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 etA <br /> (952-249-4600) upon 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 (Minimum) <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 (Mail In Only) <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 all work in strict <br /> accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements <br /> made on this application are complete,true and correct. <br /> Signature of Applicant: Date: S' �� <br />