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� � CITY OF ORONO APPLICATION FOR UTILITY PERMITS I <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER � `�` <br /> Crystal Bay, MN 55323 '' �� � <br /> i <br /> � � <br /> GENERAL INFORMATIOIv � <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 posta�e and handlin�fees shown below. Permit cards will be sent � <br /> by return mail the same day the application is received. <br /> ;. 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 Department(249-4600)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 249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: ��' � � �-�' ����S� ��� ��J <br /> Occupancy Type: � Residential Commercial <br /> Owner's Name: � � cq ; ' Phone Number: y�l � t� �`' �� ��f <br /> Mailing Address: �31 � �� �� t (Z-�7 City: � ��.= -��^ Zip: � S 3�--3 <br /> Contractor's Name:�� Q 0 1 � �,—v Phone Number: �--t� � ��1 `, <br /> Mailing Address: S���� S 4��.��:c \.� �-- City: �o c,:►-, � Zp� S S � b `�� <br /> k <br /> PERivIIT TYPE � � �^ � <br /> i�lunicipal Sewer Connection ($35.00 per stub $ ' <br /> pipe size � � inches; material�-�-�''chedule 40 air tested; cast iron <br /> SAC Charge (2000 rate $1,100.00) must accompany all sewer permit applications unless prepaid. <br /> If not prepaid, a sewer connection permit will not be issued. <br /> l�iunicipal `Vater 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 /> `Vater meters must be set and sealed by Orono Water Department(249-4600)upon completion <br /> of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks= 75' <br /> REQUIRED setback from sewer line =20' <br /> . ; <br /> PERIVIIT FEE CALCULATION --� Ci� <br /> 1. Subtotal of above permit requested $ ���� <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. PostaQe & Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ �' S� S� <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do <br /> all �vork in strict accordance ith the ordinances of the City and the regulations of the State of <br /> �linnesota, and certifies that 1 statements made on this application are complete,true and correct. <br /> � Signature of Applica t• �> � ��"�� � � Date: � �' �� d��' <br /> L--ct Zt c� `�� i - �, �.� � <br />