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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br />Box 66 (1335 So Brown Rd) SEWER WATER <br />Crystal Bay, MN 55323 <br />General I: You matey apply - <br />Ds 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 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. <br />DO NOT ExcAvATE IN ANY S4R1= 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 hour notice required. <br />JOB SITE ADDRESS: ' = '� / � � 3 F= L :Q�iG <br />Occupancy Type: 1jResidential Commercial <br />OWNER'S NAWE: Phone No.: <br />Mailing Address: City: <br />CONTRACTOR'S NAME: l �'�� L G�� � Bus. Phone : qls' <br />Mailing Address: City: L ->aC LA/4; Zip: fs <br />PERMIT TYPE AND FEE CALCULATION <br />NONICIPAL SEWER CONNECTION ($30.00 per stub) $ <br />pipe size �/_ inches; material /PVC (on sand fill); cast iron <br />SAC Charge ($700.00) 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 = $133.00; 3/4" meters = $181.00; 1" meters = $235.00) <br />$ <br />Water meters must be set and sealed by Orono Water Department (473-7357) <br />ution cemnletion 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 />$ 7 J <br />2. State Surcharge .50 <br />The State Building Code Division Surcharge o per permit must e <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 PERKIT 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 eenplete, true ro /1 <br />Signature of Applicant: /��/_� " Date: <br />J <br />