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(o,2 <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: S-g5 / ' <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: a • ,J,./ Phone Number: X 3-7E 5-%S <br /> Mailing Address: / .m ,j%wkl,w e,City: Zip:5'54/4/ 1 <br /> Contractor's Name: / ._1W./_Z/I�,MM <br /> _,.i� hone Number: 7e, --7k6-q.0-7 <br /> Mailing Address: f .i 44Zi' City: ,—c_. Zil) <br /> PERMIT TYPE <br /> Municipal Sewer.Connection ($35.00 per stub)`/ $ 3S.Di-) <br /> pipe size y inches; material X 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 $ .Oti <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 $ 70.06 <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) $ W,) 0 <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 Applica0"—� Date: o ' d <br /> or <br />