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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> . �Crystal Bay,MN 55323 � / � j� C � <br /> I 1 <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. �� � � <br /> 2. Mailed in applicarions are subject to the posta;e and handlin�fees shown below. Permit cards will be sent by <br /> return mail the same day the application is received. F <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 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. Ca11473-7357. <br /> 24 hour notice required. <br /> , _/ <br /> JOB SITE ADDRESS: S�f�`>C� '�:�: .; ;,c�' ,�'���; <' <br /> Occupancy Type: ��_Residential Commercial <br /> Owner's Name: t �,,.,( r���;�+�x-� , PhoneNumber: <br /> �Iailing Address: City: Zip: <br /> Contractor's Name: �N�,r�..nG.� �f; �, PhoneNumber: �(�:% ����� 7 <br /> l�Tailing Address: ��;r•f �c•, �'c�. I� City: ,•i�tE;:t<��c� 7�p: SS �E: <br /> F —,. <br /> PERIVIIT TYPE <br /> Municipal Sewer CQnnection ($35.00 per stub), -. $ <br /> pipe size � inches; material �-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 /> l�'Iunicipal Water Connection ($35.00 per stub) $ <br /> pipe size inches; material copper; other ` <br /> F <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 /> `Vater meters must be set and sealed by Orono Water Department(473-73�'n upon completion <br /> of ineter installation. ` <br /> REQUIRED minimum setbacks from drai�eld and septic tanks = 75' <br /> REQUIRED setback from sewer line=20' m <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 <br /> The State Buildin;Code Division Surcharge of$.50 per permit must be <br /> included for each well, sewer and water connection permit requested. <br /> 3. Postage & Handling(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 do ` <br /> all �vork in strict accordance with the ordinances of the City and the regulations of the State of <br /> Miruiesota, and certifies that all statements made on this �pplication aze complete, true and correct. <br /> '�� _. � � � <br /> j./'�—�... -�:=-�=�'�— t _ 'J.__��y <br /> Si nature of A licant: L�� Da e: <br /> g PP <br />