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(Updated 2/12/01) <br /> • <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS .,/ <br /> Boz 66 (2750 Kelley Parkway) SEWS ]WATER ( Cj <br /> Crystal Bay,MN 55323 1� �� <br /> D <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. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: b (.0/IL) °Iew <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: �- c rte,, 1�a w.e s Phone Number: 'i z - 5-90 - S`� <br /> Mailing Address: ISS , 9Y44- g City: eIc Are._ Zip: 55 l/Y7 <br /> Contractor's Name: arra-t* C0 kk. Phone Number: 50 7-244g-qep9 7 <br /> Mailing Address:z. (96)09-0 /1,1 93 City: /4Ncik-6,7•� Zip: 5-60 0ve-/ <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ �s <br /> pipe size Lo inches; material 'l 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) $ o� <br /> pipe size //2 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 (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 o� <br /> 1. Subtotal of above permit requested $ 7� <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) $ $-- <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ 70 sv <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, e and correct. <br /> Signature of Applicant: Date: _1/43', <br /> �� Pff-6 <br />