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(Updated 1/5/04) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> . <br /> Box 66 (2750 Kelley Parkway) SEWERJWATER& SAC <br /> Crystal Bay, MN 55323 � <br /> GENERAL INFORNIATION <br /> 1. You inay ap�ly for utility pennits by mail or in person at the City offices. { <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards �vill be sent by return mail the same day " <br /> the application is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the peinut card is available on the job site. <br /> 5. Utility comiection pernuts may be issued to licensed contractors only. <br /> 6. Contact the PuUlic Works Department(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the PuUlic Works Deparnnent. Issuance of a pemut does not grant this approval.�� <br /> 7. All�vork must be doue in accordauce with State Code requirements. <br /> n��`...:�. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600, 24 hour notice required. �>- ,^ <br /> ��`/� ��'/D��;� ���i'/c .���c� �� �`� <br /> JOB SITE ADDR.ESS: �� .�, <br /> Occupancy Type: �� Residential Commercial ,�` �` <br /> Owner's Name: ,�',��f°-��,� k'����� =-��=�- Phone Number: �1"�-��� ���/� �_.�� ��� <br /> Mailing Address: .C� City: Zip: � <br /> Cont�-actor's Name: C:.s�"��M� G�������'��«��.2. Phone Number: %s.� - �s�� -,5.-c�.� <br /> Mailing Add►•ess:_�ys-s c�s �� /�� City:i�>,��'l fi�z.� Zip: s s��y <br /> , <br /> PERMIT TYPE Comlections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,350.00) � (Set Rate) <br /> Sac Charge tnust accompany all sewer pennit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Co�inection/Disconnect/Repair ($35.00 per stub) $ <br /> pipe size���inches; material�Schd 40 air tested; � cast iron <br /> Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $ <br /> pipe size inches; material copper; other <br /> WATER METERS must be picked up and paid for at City Hall. <br /> Water meters must be set and sealed by Orono Water Department <br /> (9.52-249-4600) upon completion of ineter installation. <br /> REQUIRED minimtun setUacks frorn drain field and septic tanks = 75' <br /> REQUIRED setback fi-oin sewer line = 20' <br /> PERMIT FEE CALCULATION ; <br /> 1. Subtotal of above pennit requested $ <br /> 2. State Surcharae $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.SO per pernlit must be - <br /> included for each well,sewer and water connection pernut requested. <br /> 3. Posta�e & Handlin� (Only mail-in applications) $ 1.50 (Mail In Only) <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 do all work in strict � <br /> accordance with the ordinances of the City and the regulations of the State of Mirulesota, and certifies that all statements � <br /> made on this application are co�lete, true and correct. <br /> /- � <br /> Signature of Applican�-''�� ��-'�����-���� Date: �C% %'� �O�� <br />