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Mak9-001 09:16am From-CITY OF ORONO +9522494616 T-642 P.002/002 F-959 nV <br /> . . �� 3 <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 /> I. 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.�ir <br /> JOB SITE ADDRESS: /6.50Sd1- c� //,C�1��L2 <br /> Occupancy Type: R sidential Commercial <br /> Owner's Name: -. o/�� ����� __�'__ Phone N inter: ; A'� J i <br /> ?_ <br /> Mailing Address: 2.2 City: <br /> Contractor's Name: tf/1�.� / 1 ,, Phone Number• -- - <br /> Mailing Address; / 1 I City: Zip:4"/7' <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ .3.00 <br /> Ver pipe size 4/ inches; material prLSchedule 40 air tested; cast iron <br /> —"`"'1:74"' SAC Charge (2000 rate$1,150.00)must accompany all sewer permit applications unless prepaid. <br /> AIf not prepaid, a sewer connection permit will not be issued. <br /> Municipal Water C?nnection ($35.00 per stub) $ 14`p <br /> pipe size i 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 <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 $ '7 .00 <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. Postne& Handling(Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE(add lines 1-3 above) $ ,O <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 Applicant( Jiffs_ 4 . Date: 5/9/ 2 / <br /> fit if <br />