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(Lpdated 1/5/04) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Ba�•;MN 55323 <br /> GENERAL I\�'ORI�IATION <br /> 1. You may apply for utility pemuts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will be sent by return mail the same day <br /> the applicarion is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the pernut card is available on the job site. <br /> 5. Utility connection pernuts 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 EXCAVATE L\:�NY STREET AND <br /> DO I`OT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. All�ti�ork must be done in accordance with State Code requirements. <br /> 8. All��ork must be inspected before it is covered. Call(952)249-4600,24 hour notice required. <br /> JOB SITE ADDRESS: 3� �� C�c�s �� C-'� r <br /> Occupancy Type: �' Residential Commercial <br /> Owner's Name: \<a �„y �.ti�r`� u L„� Phone Number:`t � 3 C� � � � <br /> Mailing Address: City: Zip: <br /> Contractor's Name: C_-e �'Q �,:�; S a-� Phone Number: `I � �4 �� � 3 b <br /> Mailing Address:S� ��'IS1,�� �'c \� .� � r City: ��7��c,, h J Zip:SS 3�-� <br /> PERMIT TYPE ❑Connections epairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,350.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Connection/Disconnect/Repair ($35.00 per stub) $ <br /> pipe size�inches; material 4'V�Schd 40 air tested; cast iron <br /> � Municipal �Vater Connection/Disconnect/Repair ($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 <br /> ; (952-249-4600) upon completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks = 75' <br /> REQUIRED setback from sewer line =20' <br /> R PERMIT FEE CALCULATION <br /> ` 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per pemut must be <br /> included for each well,sewer and water connection pernut requested. <br /> � 3. PostaQe & Handlina (Only mail-in applications) $ 1.50 (Mail In Only) <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 all v��ork in strict <br /> � accordance�ti�ith the ordinan �s of the City and the regulations of the State of Minnesota, and certifies that all statements <br /> made on this application a omplete, true an correct. <br /> ' Signature of Applic � � Date: � � � � � <br />