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(Updated 6/2/03) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS f06?V. <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)249-4600,24 hour notice required. <br /> JOB SITE ADDRESS: .21 0 i ' \I\ `- i V e`,.� f�`- <br /> Occupancy Type: '� Residential Commercial <br /> Owner's Name: .1) C '-k-o o, e- Phone Number: <br /> Mailing Address: City: Zip: <br /> Contractor's Name: CoQ Q \ cam) S 9-"v Phone Number: ct. -� 1f 7 . Z3I b <br /> Mailing Address: Co 9 S 1,,,z3 �(.. t- ,- e_ C)— City: /17 o c i hi Zip: S S 5 f <br /> PERMIT TYPE ig'C;onnections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,275.00) $ (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 onnection/Disconnect/Repair($35.00 per stub) $ <br /> pipe size Et( inches; material p(C-Schd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect/R•($35.00 per stub) $ <br /> pipe size I u inches; material /c/ 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 <br /> 1. Subtotal of above permit requested $ <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 ordinancesif the City and the regulations of the State of Minnesota, and certifies that all statements <br /> made on this application areplete, truean• orrect. <br /> Signature of Applicant: .,.IA JdL L....41014/./ Date: ( o ,e73 <br />