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JCITY OF ORONO APPLICATION FOR UTILITY PERMITS <br />Box 66 (1335 So Brown Rd) SEWER WATER <br />Crystal Bay, MN 55323 <br />I: You may app y or 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 dayy the application is received. <br />3. Pezmits are not valid until you receive a permit cmrd. <br />4. Fbrk must not begin unless the permit card is available on the job site. <br />5. Utility connection permits may be issued to licensed oontractors only. <br />6. Contact the Public Works Department (473-7357) for utility stub as -built locations. <br />DO NOT MokVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the <br />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 473-7357. <br />24 how notice required. <br />JOB SITE ADDRESS: 41•l <br />Occupancy Type: L Resi a tial Commercial <br />011HRR' S NAME: Phone No . : <br />Mailing Address: City: <br />©OITRACTOR' S NAME: Bus. Phone <br />Mailing Address: zip: �S <br />*�***�*�A*+kf1�t►*f�►*�*��****�**err***�t***��*******�***�!�*** '�c <br />��; ��. PERMIT TYPE ACID FEE CALCULATION <br />MUNICIPAL SEWER COMMerIOM ( $3��9fl per stub) $ � ",I " <br />pipe size inches; material PVC (on sand fill); cast iron <br />SAC Charge ($700.00) must accompany all sewer permit applcations unless <br />prepaid. If not prepaid, a sewer connection permit will not be issued. <br />3�.(I <br />MUNICIPAL WATER CONNECTION ($36Ts6 per stub) $ <br />pipe size inches; material copper; other <br />WATER METERS must be picked up ana'paid for at City Aa <br />(5/8" meters - $133.00; 3/4" meters - $181.00; 1" meters - $235.00) <br />Water meters must be not and sealed by Orono Water Department (473-7357) <br />upon completion of meter installation. <br />REQUIRED minimum setbacks from drainfield and septic tanks - 75' <br />REQUIRED setback from sewer line - 20' <br />1. Subtotal of above permit requested $ <br />2. State Surcharge .50 <br />The State Building Code Division Surcharge o per permit muse <br />included for each well, sewer and water connection permit requested. <br />3. Postage a Handling (Only mail -in applications) $ 1.50 <br />4. TOTAL PERMIT FEE (add lines 1-3 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 oa:plete, true a90'oorrect , <br />Signature of Applicant: - Date:�'- <br />