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ITY RONO APPLICATION FOR UTILITY PERMITS 6-'.7 U <br /> C <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 fees shown below. Permit cards will be sent <br /> by 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 (473-7357)for utility stub as-built locations. DO NOT EXCAVATE <br /> IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works <br /> 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 473-7357. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: I nap UOLQ Yl,i 1 1'v' t ��n.�t-Q..,. <br /> Occupancy Type: X Residential Commercial <br /> Owner's Name-01,} WIDAAE-. 4_ kSyCX1- PhoneNumber: <br /> Mailing Address: City: Zip: <br /> Contractor's Name:\\c\v f-1 \b\ (", PhoneNumber: q 3- ti''i 1'� 2, <br /> Mailing Address:l 5 `(`rl`�rMc�ka City: `(JLC tip: -"Sc- 34S' <br /> PERMIT TYPE <br /> Municipal Sewer onnection ($35.00 per stub) $ ?)J. <br /> pipe size —I inches; material PVC (on sand fill); cast iron <br /> SAC Charge ($800.00) must accompany all sewer permit applications unless prepaid. If not <br /> prepaid, a sewer connection permit will not be issued. <br /> Municipal Water 'onnection ($35.00 per stub) $ -? <br /> ,__:'o e- inches; material copper; other <br /> a�`--�`ATER ' 'I !S must be picked up and paid for at City Hall. <br /> (5/8 ' meters — $133.00; 3/4" meters = $181.00; 1" meters = $235.00) <br /> Separate.Plumbing Permit issued for water meter. <br /> Water'meters must be set and sealed by Orono Water Department (473-7357) upon <br /> completion of meter installation. <br /> REQUIRED minimum setbacks from drainfield 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 $ _- �� , '' j <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) $ ? - <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 <br /> do all work in strict accordance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> ----� .Er Z Date: c - 3 R 5_' <br /> Signature of Applicant:71 l,rl,� <br />