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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 /> i� '. ! <br /> GENERAL INFORMATION �j <br /> 1. You may apply for utility pernuts 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 retum mail the same day the application is :eceived. <br /> 3. Permits are not valid until you receive a per�riit 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. Call 473-7357. <br /> 24 hour notice required. <br /> JOB STI'E ADDRESS: �3 � �� ���Si�J� <br /> Occupancy Type: ✓' Residential Commercial <br /> Owner's Na.•ne:���,0 �t /� �'✓n /-� PhoneNumber: �1 i4"��-�J �� ��� <br /> Mailing Address• � �y 6 �� �� f',�l��,�' City: r � � �r�; Zip:�"�'�5 G <br /> Contractor's Name: Gf��� w ����-�`v,v PhoneNumber: �.>,; - ���r�� <br /> Mailing Address: �'�t��;�/m���L. City: �� A.�!, c ^- k,r Zip: '>�'�-;'> <br /> PERMIT TYPE '� <br /> Municipal Sewer Connection ($35.00 per stub) $ � S U v < <br /> pipe size � inches; material y o PVC (on sand fill); cast iron <br /> SAC Charge ($750.00) 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 /> 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 /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department (473-735'� upon <br /> completion of ineter installation. <br /> REQUIRED minimum setbacks from drainf'ield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <br /> PERMIT FEE CALCULATION _, <br /> 1. Subtotal of above permit requested $ � �- d�' <br /> 2. State Surchar�e $ .50 <br /> The State Building Code Division Surcharge of$.50 per permit must be �" � �" ' <br /> .� �.; � <br /> included for each well, sewer and water connection permit requested. <br /> 3. Posta�e & Handlin� (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 <br /> do all work in strict accordance with the ordinances of the City and the regulations of the Sta.te <br /> of Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> � c- . <br /> . r`' , — ; ,� �.. <br /> Signature of Applicant: .�' �� '� �"' *� –( <br />