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�:'a'ated .�.�12��1� <br /> ; <br /> CITY OF ORONO APPLICATION FOR UTILITY PERiVIITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 <br /> �NERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. R <br /> 2. Mailed in applications are subject to the postage and handlin�fee shown below. Permit cards will be sent by <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 Department (952-249-4600) for utility stub as-built locations. DO NOT <br /> EXCAVATE IN AN�STREET AND DO NOT TAP ANY MAIN without express approval of the Public <br /> Works 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(952)249-4600. <br /> 24 hour notice required. <br /> i�;� ' � � � <br /> JOB SITE ADDRESS: i✓ �'��cT=�-'�✓ �-� �� - <br /> Occupancy Type: � Residential Commercial <br /> Owner's Name: `o,r� ,c ��s Phone Number: ,`��3� `�7 3 '`ll��� <br /> Mailing Address: j5' ���:vN /�✓, 5�,. City: 7�: <br /> Contractor'sName: �'u����.c�,�����c i �re s l��c��'hone Number: i�'S��i�%3-�i'3C� <br /> Mailing Address: � � � �� ty: � Zip: `"-'-'`' <br /> � � � �� /_n.i so� c� �� �� ��;,�- �� .��i <br /> PERIVIIT TYPE . <br /> � Nlunicipal Sewer Connection ($35.00 per stub) $ � <br /> pipe size�inches; material Schedule 40 air tested; cast iron ' <br /> SAC Charge (2000 rate $1,150.00) must accompany all sewer permit applications unless prepaid. <br /> If not 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 /> Water meters must be set and sealed by Orono Water Department (952-249-4600) upon <br /> completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks = 75' <br /> REQUIRED setback from sewer line =20' <br /> PERMIT FEE CALCULATION � <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. Posta�e & 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, ab ees 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 statements made on this application are complete,true and correct. <br /> , <br /> Signature of Applicant: � ,�- Date: %� '' /� f <br />