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CITY OF ORONO APPLICATION FOR UTILITY PERMITS `��' ` �'`` <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 <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 pernut 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 /> 8. All work must be inspected before it is covered. Call 473-7357. <br /> 24 hour notice required. <br /> I <br /> JOB STI'E ADDRESS: -� y'-��-> �f�, � � ,�-�- / �� �,,,> � -- ��% � � /'��r� <br /> Occupancy Type: �- Residential Commercial <br /> Oe�nPr's Na*r�e: ��r�;� l�(/�r7D/ 'r �' ,t"��;-�•� PhoneNumber. � � ' `�';��,' __'_ '�'_�� <br /> Mailing Address: City: 7ip: <br /> � - <br /> Contractor's Name: ���,�� '�� �'��r�'• sr>�- PhoneNumber: � 1��i.�'�-� �� �-�:x <br /> Mailing Address:�, �� � �� � --,� f��� - City: � -i, 'i� 7ip: - -_-;��-� <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) � �_�: . ; �� � <br /> pipe size 1/'� inches; material 1,� 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; other <br /> VJATER 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 VVater Department (473-7357) upon <br /> completion of ineter installatian. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ `' '� \ <br /> , , . ��.� <br /> 2. State Surchar�e $ .50 <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each well, sewer and water connection permit requested. <br /> 3. Postage & Handlin� (Only mail-in applications) $ I:SD <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) � f� _" � ' � <br /> , <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 /> /' � '�� i�> / <br /> Signature of Applicant: �% - � _'�- �� � ` <br /> / <br /> � <br />