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CITY OF ORONO 'z iti <br />Box 66 (135 So Brown Rd) APPLICATION FOR UTILITY PERMITS <br />Crystal Bay, MN 55323 SEWER WATER <br />General <br />tions <br />1. You may�apply for utility permits by mail or in persor 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 save day the application is received. <br />3. Pewits are not valid until you receive a permit anrd <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 E}CCAVATE IN ANY SII2 M 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 boor notice required. <br />JOB SITE ADDRESS: <br />Occupancy Type: <br />Tf 6 Alf, <br />siaentia <br />commercial <br />OWNER'S NAME: _ Z110 r( It f Phone No.: `l 33._ 5,/S <br />Mailing Address: _S,4K1,e City: ,h, �✓l7?��/iC.4 , lrin/ SS.#3 <br />CONTRACTOR'S NAME: L1601I / A Bus. iJbone <br />Mailing Address: �� rr� City: eVXA. zip: <br />**,r,►***t**,►�r*:**s***s****:*�***,►,r**+r****:***,r�*•*****,r,r**,r**s�*�***,►,r����F <br />3 a cPERMIT TYPE AND PER CALCULATION <br />MUNICIPAL SEMM CONNECTION ( 36A per stub) $ <br />pipe size inches; material PVC (on sand fill); cast iron <br />SAC Charge ($700.00) must accompany all sewer permit app-Tcations 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 />Water meters must be set 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 must e <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 complete, true and correct. <br />Signature of Applicant: - <br />!�' Rate: �J� <br />