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�' <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> I3ox 6G (2750 Kelley Parkway) " � SEWER/WATER <br /> Crystal Bay, MN 55323 <br /> GENI;RAL INFORMATION <br /> I. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postagc a�ld handling fees shown below. Permit cards will be sent <br /> by rcturn 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 bcgin unlcss tlic permit card is available on thc job sitc. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Dcpartment (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. tssua�ice 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:� f� ��ti P � � _ ' <br /> Occupancy Type: Re ide _ al Commercial <br /> Owner's Name: � f , �-��-vc.-�•�' PhoneNumber:�7�/--�l3 Z. � <br /> Mailing Address:. -- City: 7�p: <br /> Coiitractor's Na�ne: �" honeNumber:�/���<jc�t�`� <br /> Mailing Address: > 1 � ;�, � City:l��� 7�p:� <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ <br /> pipe size � inches; material _� PVC (on sand fill); cast iron <br /> SAC Charge ($850.00) must accompany all sewer perrnit 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; other <br /> WATER MCTERS 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 ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <br /> P�RM1T FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State SurcharQe $ .50 <br /> The State Building Cocle Division Surcharge of$.50 per permit must be <br /> included for each well, sewer and water connec[ion permit requcsted. <br /> 3. Postage & Handlin� (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. <br /> � / � <br /> Signature of �lpplicant• ' Date: �//�1�� <br />