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� D�t04-2001 12:44pn frort{11Y OF ORONO � �� +p5224o4616 T-2G7 P.001/001 F-305 <br /> ' ` �� �V�tl7l4�M11!r/14JU11 <br /> . � <br /> CITY OF ORONO A.PPLFCATION FQR UTILTTY PERMITS <br /> BaY 66(2750 KcUcy Perkway) � SEWER/WATER <br /> Crysta!Bay,MN SS323 � <br /> 3�� <br /> ��°� <br /> CENE L INFORMATION <br /> �0,� 1. You may sppty for utiliry permits by m�il or u►persan at the City offices. <br /> 2, Mailed in applications ure aubject to the postage and han�ing fee showa below. Permit cards will be sent by <br /> return mnil the same day the application is rec�;ived <br /> 3, Permib are oot v�(id unti!yon receive a permit card. <br /> 4. Waic must not begin unless the permit cerd ia available oe the job site, <br /> 5. Utility connxtinn perniita may be issued tu lic�nsed cantractors only. <br /> 6, Contact the Public Works Depa�tmeat (95?-249�600) for utility stub as-built lncations. pQ NQT <br /> IXCAVA'TE IN ANY S'�'RE�T AIv'D DO NC�T TAP ANY MAIN withont acpress approval of the Public <br /> WoQics DepartmeaL Issuance of a permit does not pant this�ppmval. <br /> 7. AEI wark tnust be done in accordence with Sta�e Code ree,uiremants. <br /> , 8. AA wark mtLat bc inspoeted b�fore it is covere�l, G�11(952)249-4600. <br /> 24 hour notice req�ired. <br /> JOB SI�'�ADDRTSS: �'1(Q[� 1JD. �Jt t�w n ��- <br /> Occupancy'I�ype: �Residential Commerciat <br /> Ovraer's N�a�: �o.r�.s �.�;���-�- Pboae N�ber: <br /> Maebing Addraa��(a IJo. gro�� t�• City: O�o�c 7_i�x <br /> Contractor'aNatpe`l��,m��-��IUr��C�a;�_ PboncNambercS3- �j3�._'l`ll�, <br /> Mailing Addres::l`�,��,� �M�� �-�' r� � City: f�S�.��_ "T�pa �� <br /> P�1tMTT TYPE <br /> Muaicipal Sewer Connechon($35.Oa per stub} $ <br /> 11�'r�� pipe siDe�inch�es; material,,,�_Schodule 44 air tested; cast iron <br /> a"'� SAC Charge(2400 rate$1,150.00)must gcw�nipa.n�aIl sewtr ptacnit applicatians unless p�paid. <br /> �� r If uot prepaid,a sew�er con.nectioa permit will�wt be issu�d. <br /> 1Kunicipal ter C nection(�35.00 per stub) $ <br /> pipc a' inehes; material �copper; other <br /> �� �„o„�VA'TER ME must bc pickcd up and pai�i for at City Hall. <br /> v`�Water m m t be sct nnd seat,ed by (lrono Water Deparbnent {952-?�9-4600) apon <br /> co oa of inett Luzbllxtion. <br /> � REQt�T) ' ' um sctbacks from dr�.in field and septic taulcs=75' <br /> REQYJ�sctback from scwcr line=20' <br /> p�MTT��E S�SI.�CULATIQI� <br /> l. Subtotal of abavc permit r�qucstcd $ <br /> 2. Statc Sur�c_t�� $ .50 <br /> 'Ihe State Building Codc Divisioa Surchargo of S.SO per permit must be <br /> iacluded for aac�i well,sewer and water eonne�tion permit requ�sted. <br /> 3. Postage&�andling(4nly mail-in applications) � 1.50 <br /> 4. TOTAL PERMIT FEE(add linos 1-3 above) � <br /> T'he undersi�ned hereby applics to the City of�hano for issuance af n Utility Permi� agrccs to do <br /> all worlc in siriei �cxordenct with thc omdinan�:es of the City and tbe rt�ulations of thc State of <br /> Minncsota,and certifies that nll statements made on this applicatioa sre compkt�,true and coaect_ <br /> Signature of Applicant�/ � �-� ��/,t��r�a n bate: /U �0,71 - Z <br />