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(Updated 5/3/02) <br /> CITYOF ORONO APPLICATION FOR UTILITY PERMITS13 <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <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 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)249-4600,9- 24 hour notice required. <br /> JOB SITE ADDRESS: eso w,L�o,vi Ew bk. <br /> Occupancy Type: X Residential Commercial <br /> Owner's Name: {`�V C 0001ES Phone Number: <br /> Mailing Address: City: Zip: <br /> Contractor's Name: ,J _ .5c F_wg1kT Corm owl 6' S Phone Number: 7C,3 -yig -7c.63 <br /> Mailing Address: 5roc, 95/7H ,Iva_ /J City: E,,vy&j Zip: 55'35-7 <br /> PERMIT TYPE =1 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 Connection/Disconnect/Repair($35.00 per stub) $ 31-' <br /> pipe size y inches; material $ Schd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect/Repair($35.00 per stub) $ 3 Som <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 <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 c Q <br /> 1. Subtotal of above permit requested $ I 0 <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 . : • .lete, true d c.. ect. <br /> Signature of Applicant: ii���/A� / ' Date: 7-16 "°Z <br />