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CITY OF ORONO Al'P.LICAT1ON FOR UTIL11A 1'E1tMITS <br />Box 66 (2750 Kelley Parkway) SEWER/WATER <br />Crystal Bay, MN 55323 t <br />GENERAL INFORMA1ION <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 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 (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 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 hour notice required. <br />JOB SITE ADDRESS: <br />Occupancy Type: Y ResidedillaW <br />Owner's Name: jt' G' 644 1121 ,�' 1rA 77 <br />Mailing Address: <br />Contractor's Name: <br />Mailing Address: f iyp 1T�S S <br />PERMIT TYPE <br />Commercial <br />Phone Number: <br />City: zips <br />PlimNumber: <br />City: < o P t J7e 24K; <br />Municipal Sewer Connection f�35.00 per stub) $ <br />pipe size � inches; material � PVC (on fit}; <br />SAC Charge ($800.00) must accompany all sewer permit applications unless <br />prepaid, a sewer connection permit will not be issued. <br />Municipal Water Comaection ($35.00 per stub) <br />pipe size inches; material _ _ copper; <br />WATER METERS must be picked up and p,:.-. for at City Hall. <br />(5/8" meters = $133.00; 3/4" metti.: = $181.00; <br />$ <br />other <br />cast iron <br />prepaid. If not <br />I" teeters = $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 $ <br />2. Stateurc r e $ .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. Postage & 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, 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 all statements made on this application are complete, true and <br />correct. i 64 ��.�^� • �."..� f--�,,.k` �i� <br />�� `I' Signature of Applicant: ' %�%G�✓F fJ�'�1*��- - — Date: <br />