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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 /> *************************�************************************************* ` <br /> I: You mal�pply�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. ' <br /> Permit cards will be sent by return mail the same day the application is received. <br /> 3. P�nnits are mt valid imtil you reoe.ive a pemnit c�rd. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connection permi.ts 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 SZREET AND DO NOT TAP ANY MAIN without express approval of the ; <br /> Public Works Depart-ment. Issuance of a permit does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. Al1 work must be inspected before it is covered. Call 473-7357. <br /> 24 haur notioe rec��;red. <br /> *************************************************************************** <br /> � <br /> JOB SITE ADDRESS: s� ��� �S '� i � ��J<< ��v� <br /> Occupancy Type: k Residential Commercial <br /> OWNER'S NAME: i�,�-'�'1�j��T- /-f,r�/�� Phone No. : <br /> Mailing Address: �, ; �r s,- �7 � y ;-� r.�,�,�- �� z� City: �� �1 ����� �, <br /> CONTRACTOR'S NAME: ���'' 2� i� �x`�� S��! Bus . Phone: `/�;' � `� ����' <br /> Mailing Address: -�.> ,� %1�7i.>7 �,--�c City: �•�� e� '��<.- Zip: ��:� ��� <br /> *************************************************************************** � <br /> -_ PERMIT TYPE AND FE$ CALCULATION <br /> MUNICIPAL SEWER CONNECTION ( $30. 00 per�tub) $ �3 �5 ��' <br /> pipe size inches; material `iPVC (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 /> MIINICIPAL 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 ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' � <br /> ; <br /> REQUIRED setback from sewer line = 20 ' <br /> *****************************************************************�********* :' <br /> 1. Subtotal of above permit requested $ "� � � � <br /> 2. State Surcharge . 50 <br /> The State Building Code Division Surcharge of .50 per permit must e <br /> included for each well, sewer and water connection permit requested. <br /> 3 . Postage � Handling (Only mail-in applications) $ 1. 50 <br /> _� � - ,�, �� <br /> 4. TOTAL PERIKIT FEE (add lines 1-3 above) $ � � <br /> *************************************************************************** ; <br /> __._ _ . <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 d c�r� <br /> F <br /> ��/ � � <br /> Signature of Applicant- �>���� . / -< � Date: L� �"� 1� � � J <br />