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. � (U�:iated 2/12/O1) <br /> CITY OF ORONO APPLICATION FOR UTILITY PER�VIITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City o�ces. <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 ANY 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(9�2)249-4600. <br /> 24 hour notice required. <br /> � � <br /> JOB SITE ADDRESS: S�� � C�SLD �o��� �( �C- P <br /> Occupancy Type: _ � Residential Commercial <br /> Owner's Name: 1.� /}�,� ��-4�t Se�l Phone Number: <br /> Mailing Address: City: 7ip: <br /> Contractor's Name: es�'o n . Phone Number: 5� � �f�-�� � <br /> Mailing Address: (9��C Co� �2 , f S City: ��'u��c( 7�p: �'S.3'�5� <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub� _� $ <br /> pipe size�_inches; material �� Schedule 40 air tested; cast iron <br /> -f\C_ <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 c pper; other <br /> WATER METERS must be picked up and pa� Cin� Hall. <br /> Water meters must be set and sealed by Orono `�'ater 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 FE� CAL�ULATION <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 & 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 do <br /> all wark 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 thi are complete,true and correct. <br /> Signature of Applicant: Date: � / ?' �� <br />