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CITY OF ORONO APPLICATION FOR UTILITY PERMITS (Updated 12/29/04) <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 <br /> 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)249-4600,24-48 hour notice required. <br /> JOB SITE ADDRESS: /DOS— Will bvtl U t t_ti <br /> Occupancy Type: )( Residential Commercial <br /> Owner's Name: L G r 0.Y, c,,,c 5 Phone Number: <br /> Mailing Address: City: Zip: <br /> Contractor's Name: P rzc Go,-,--c-ct p.��t a Phone Number: Sb7 a ye, qt, 7 <br /> Mailing Address: ?)cc--p)o ct.k.e_ tlwy 9 3 City: n pfe r5o.-, Zip: o,-1 y <br /> PERMIT TYPE Connections n Repairs ['Disconnect (Check One) <br /> SAC Charge (2005 rate $1,450.00) $ (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) $ <br /> pipe size t/ inches; material x Schd 40 air tested; cast iron <br /> �� <br /> Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $ 3,�. <br /> pipe size I 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 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. L <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) $ -:-50 (Mail In Only) <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ '7 . 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 complet , e and correct. <br /> Signature of Applicant: d1/2.0,,A, Date: c.,,,?3` OS' <br />