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Doc-04-2001 12:44pm From-CITY OF ORONO +9522494616 1-297 P.001/001 F-805 <br /> kid pun.mu 4,th/u ) <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 u t 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. 1)0 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. Ail work must be done in accordance with Stagy a Code requirements. <br /> 8, All work must be inspected before it is coverer 1. Call(952)249-4600. <br /> 24 hour notice required. <br /> .TOE SITE ADDRESS: <br /> Occupancy Type; Residential Commercial <br /> Owner's Name n.�_.1:. Phone Number: <br /> Mailing Address: ��L• i�'tet . City: Zip: <br /> Contractor's Nar#tef\4�.�� E�\��:\. _ Phone Number: \ • <br /> Mailing Address:t'_. . , ti .11 r. =��f� :��. . ��_��:� City: i l��t' � T L.) <br /> PERMIT TYPE C � <br /> �ri Municipal Sewer Connection ($35.00 per stub) $ <br /> J 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 /> u,)( If not prepaid,a sewer connection permit will not be issued. <br /> Municipal Water Connection($35.00 per stub) $ f_ <br /> pipe size inches; material_ _copper; other 1 <br /> WATER METERS must be picked up and paid for at City Hall. / f <br /> Water meters must be set and seated by Orono Water Department (952-249-4600) upon <br /> completion of meterkastallation. <br /> REQUIRED minimum setbacks from drain field and septic tanks=75' <br /> REQUIRED setback from sewer line=20' <br /> PEE TFE.E CALCULATION <br /> 1. Subtotal of above permit requested y$i <br /> 2. State Surcharge $ .50 <br /> The State Building Code Division Surcharge of$.5o per permit must be <br /> included for each well,sewer and water conn(lion permit requested. <br /> 3. Postage& ndling(Only mail-in applications) $W 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 Applican i a'" — (“2--74/2, Date: /C7 <br />