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Auj OT-2002 '0:03am Fram-CITY OF 0R0^fC +9522494616 T-TOT P.002/002 F-329 <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 return mail the same da; <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 ANL <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. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: , Q`�) Li t9tt- Pti-oRsr i2Frl L <br /> Occupancy Type: V Residential Commercial <br /> Owner's Name: Clot, 1-.11-0^,/+.5 L-irD t,t 5 Phone Number: P 41 5`)— _ciC,2 <br /> Mailing Address: \ co\ WA �40--a r31/44Y,)./t -2-le City: \A,n(1_,M-A Zip: <br /> Contractor's Name: Phone Number: N6t1..4 i . �g j <br /> Mailing Address: t 7u_ /1 , ,2„ L'vo)y City: PP-w4-LA--r Zip: -?d <br /> PERMIT TYPE ' <br /> Municipal Sewer Connection($35.00 per stub) $ <br /> pipe size inches; material Schedule 40 air tested; cast iron <br /> SAC Charge (2002 rate$1,200.00)must accompany all sewer permit applications unless prepaid. If not prepaid,a sewer <br /> 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 completion of meter <br /> 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 S :3� <br /> 2. State Surcharge $ .S0 _ <br /> The Stare Building Code Division Surcharge of 5.50 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) $ , 5''U <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: (140e Date: 'c3' <br />