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i <br /> CITY OF URONO APPLICATION FOR UT'ILITY PERNII'TS '�� <br /> 13ox GG (2750 Kelley Parkway) S�WEIt/WATER _, ` <br /> � Crystal I3ay, MN 55323 ��`f � <br /> � � - <br /> � CGNI;RAL INFORMATION <br /> l. You may apply for utility permits by►nail or in person at tl�e City offices. <br /> 2. Mailed in applications are subject to the postabe and handling fees shown below. Permit cards�vill 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 ouly. <br /> G. 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 Stnte Code requirements. <br /> 8. All work must be inspected before it is covered. Call 473-7357. <br /> 24 hour notice required. <br /> JOBSITEADDRESS: /,)���� ,��.';<_��� ��,�,�, i ���:% <br /> Occup:�ncy Typc: x Residcntial Commcrci�l � <br /> O�vner's Name: �'��/�, � ��,�1�;� ,`';��i�F;�� ,� Phone Number: <br /> Mailing Address: City: 7ap: <br /> Contr�ctor's Name: , j `� ;�������<�;- �.,�,;;.�,�_�,._;�,�-cPhone Number: ;����-���.>i/ <br /> Mailiug Address: -� ���� r.��.�`,-r�-v _�.- City: ��";�";�r 7�p. �-.-,, ; <br /> =� <br /> PERNIIT TYP� <br /> Municipal Setiver Connection ($35.00 per stub) $ 3��"�' <br /> pipe size�inches; material^�PVC (on sand fill); �cast iron <br /> SAC Charge($850.00)must accompany all sewer pennit applications unless prepaid. If not prepaid, <br /> a sewer connection permit will not be issued. <br /> Muuicipal W�ter Cpnnection ($35.00 per stub) $ �j"`� <br /> pipe size�inches; material co er• odier <br /> —,� PP � <br /> WATER MF,TERS must be picked up and paid for at City Hall. <br /> (5/8" meters = $139.00; 3/4" meters = $191.00; 1" meters = $247.00) <br /> Separate Plumbing Permit issued for water meter. <br /> W�ter mcters must be set and sealed by Orono Water Depnrtment(473-7357)upon completion <br /> of mctcr installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> IZ�QUIRED setback from sewer line = 20' <br /> PrRMIT FI;F, CALCULATION <br /> 1. Subtotal of above permit requested $ l0�`� <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. Postage & 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, agrees 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 /> Si�nature of Applicaul: ��_ �O _ Date: �j �27���' <br />