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l.11 l W. VIIVi,V Nll'L11,ri11V1� 1'Vl% U11L111 1L'lU�ll1J <br />�. fox 6b (275Q Kelley Parkway) Crystal Bay, MN 55323 SEWER/WATER <br />GENERAL INFORMATION <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 />g. All work must be inspected before it is covered. Call 473-7357. <br />24 hour notke required. <br />JOB SITE ADDRESS:O <br />Occupancy Type: Reside ial <br />Owner Name: c�- o %Crar <br />Mailing Address: <br />Contractor's Name: <br />Mailing Address: �C('�xSeS` <br />Commercial <br />PhoneNumber: <br />City: Zip; <br />Phone Number: y 7 7` S 0 7 7 <br />PERMIT TYPE <br />Municipal Sewer Connection ($35.00 per stub) $ <br />pipe size __�__ inches; material r/ PVC (on sand fill); cast iron <br />SAC Charge ($800.00) must accompany all sewer permit applications unless prepaid. If not <br />prepaid, a sewer connection permit will not be issued. <br />Municipal Water Connection ($35.00 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 = $133.00; 3/4" meters = $181.00; 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 />I . Subtotal of above permit requested $ <br />2. State Surcharge <br />The State Building Code Division Surcharge of $.50 <br />included for each well, sewer and water connection permit permit must be <br />permit requested. <br />3. Postage & Handling (Only mail -in applications) $_ 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 all statements made on this application are complete, true and <br />correct. <br />Signature of Applicant: 4m, / <br />Date: � /E <br />