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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br />Box 66 (2750 Kelley Parkway) SEWER/WATER <br />Crystal Bay, MN 55323 <br />GENERAL UffORMATItNI <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 fees shown below. Permit cards will be sent <br />by return mail the same day the application is received. <br />3. Permits are ntrt vaUd umil you receive • perark card. <br />4. Work must not begin unless the permit card is available on the job site. <br />S. Utility connection permits may be issued to licensed contractors only. <br />6. Contact the Public Works Department (473-7357) for utility stub as -built locations. DO NOT EXCAVATE <br />IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works <br />Department. Issuance of a permit does eta 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 473-7357. <br />/ 24 hour notice required. n <br />JOB SITE ADDRESS <br />Occupancy Type: RedduKW Commercial <br />Owner's Name: 141PhoneNumber-y_n <br />Mailing Address: City: Z✓a_T�-�, <br />Contractor's Name: PhoneNtmber — _ <br />Mailing Address: City.A7 4'.r— <br />PERMff T_1'_P� <br />Municipal Sewer C rtnection (S35.00 per stu S <br />pipe size inches: material PVC (on sand fill); cast iron <br />SAC Charge (5800.00) must accompany' all wer permit applications unless prepaid. If not <br />prepaid, a sewer connection permit will wt be issued. <br />Municipal Water Connection (S35.00 per stub) <br />pipe size inches; material copper; otter <br />WATER METERS must be picked up and paid for at City Hall. <br />(5/8" meters = S133.00: 3/4" meters = S181.00; 1" meters = $235.00) <br />Separate Plumbing Permit issued for water meter. <br />Water meters must be set and sealed by Orono Water Department (473-7357) upon <br />completion of meter installation. <br />REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br />REQUIRED setback from sewer line = 20' <br />PERMIT FEE CALCULATION <br />1. Subtotal of above permit requested 5 <br />2. State Surcharge S .50 <br />The State Building Code Division Surcharge of S.50 per permit must be <br />included for each well, sewer and water connection permit requested. <br />3. Postage 6t Handling (Only mail -in applications) S 1.50 <br />4. TOTAL PERMIT FEE (add lines 1-3 above) S <br />The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to <br />do all work in strict accordance with the ordinances of the City and the regulations of the State <br />of Minnesota, and certifies that ail statements made on this application are complete, we and <br />correct. <br />Signature of Applica6t: � .d r � 1 �1/yz <br />