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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 /> � " <br /> GE1�IERAL INFORMATION � ���� <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications aze subject to the postage and handlin�fees shown below. Permit cards will be sent by :j � �_`� <br /> 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 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 Deparhnent(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. Ca11473-7357. <br /> 24 hour notice required. <br /> �•, <br /> JOB SITE ADDRESS: � 5 �'� ,���� � • ` ���r�� /��'�r'� � <br /> Occupancy Type: /.�_Residen ial Commercial <br /> Owner's Name: f`re v 1 �� �!�:;',�--- Phone Number: <br /> Mailing Address: 52�.-�.- City: 7.ip: <br /> Contractor's Name: C rt il�? �- r�c ��' Phone Number: �� a � ���� <br /> Mailing Address: 7/�� u��,�y �� �� City:E�� /`4!`���`�� r�p: �� <br /> 7 <br /> PERMIT TYPE --� <br /> Municipal Sewer Connection ($35.00 per stub� $ � �` � (> <br /> pipe size�inches; material 1"U��Schedule 40 air tested; cast iron <br /> SAC Charge ($1,000.00) must accompany all sewer permit applications unless prepaid. If not <br /> prepaid, a sewer connection permit will not be issued. <br /> I��Iunicipal Water Connection ($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 /> (5/8" meters = $139.00; 3/4" meters = $191.00; 1" meters = $247.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department(473-73��upon completion <br /> of ineter installation. <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 $ ? s� ��� <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. Posta�e & HandlinQ (Only mail-in applications) $ -�� <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ 3 �• ��� <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all stat�ments m�e on t�is application are complete, true and correct. <br /> / F \ p <br /> Signature of App <br /> lic t: �' ��� Date: �! �� �L� <br />