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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br />Box 66 (1335 So Brown Rd) SEWER WATER WML <br />Crystal Bay, MN 55323 <br />General Instructions <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. <br />Permit cards will be sent by 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 Citv offices for utility stub as -built locations. DO NOT EXCAVATE IN ANY <br />STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works <br />Department. Issuance of a permit does not grant t.iis 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. 24 hour notice <br />required. <br />******#*###*##*****#*#******##***************##*##***#***##*#*****#**#*##* <br />JOB SITE ADDRESS: _2o <br />Occupancy Type: x Res'id,6ntiai Commercial <br />c' <br />OWNStt'S RAMS: -b Phone No.: <br />Mailing Address: City. _ <br />I <br />CONTRACTOR'S NAME: r .� l C n Bus. No.: q� Z� 3 311 0 <br />Mailing Address BS)4-;2q0 £ rc�rji r��, City: 0r (a, - <br />Master Plumber's State License No.: City Cert, No.: <br />PERMIT TYPE AND FEE CALCULATION <br />MUNICIPAL SEWER CONNECTION ($30.00 per stub) $ <br />pipe size inches; material PVC (on sand fill); cast iron <br />SAC Charge S550.00) must accompany all sewer permit applications unless <br />prepaid. If not prepaid, a sewer connection permit will not be issued. <br />MUNICIPAL WATER CONNECTION ($30.00 per stub) $ <br />pipe size inches; material copper; other <br />WATER METERS must be picked up and paid for at City Hall. <br />(5/8" meters = $95.00; 3/4" meters = $130.00) <br />PRIVATE WELL INSTALLATIONS ($30.00 per job) $ <br />Check: 7< New Replacement Repair Adandonment <br />Casing size: inches <br />(Instaliattron-of new/replacement well covers abandment of old well, <br />Well Abandonment - not concurrent with installation of new/replacement <br />well requires a separate permit) <br />REQUIRED minimum setbacks from drainfield and septic tanks 75' <br />CALL FOR A SITE LOCATION BEFORE DRILLING <br />Upon completion, City must be sent a copy of State well ,ord. <br />1. Subtotal of above permit requested $� <br />2. State Surcharge .50 <br />The State Building Code Division Surcharge of .`_0 per permit must be <br />included for each well, sewer and water connection permit requested. <br />3. Postage i Handling (Only mail -in applications) $ 1.50 <br />4. TOTAL PERMIT FEE (add lines 1 above) $ <br />The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, <br />agrees to do all work in strict accordance with the ordinances of the City and the <br />regulations of the State of Minnesota, and certifies that all statements made on this <br />application are complete, true and correct. <br />Signature of Applicant: -aJ- l,� uiN� Date: �,_ u <br />