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� <br /> ' CITY OI' ORONO APPLICATION FOR UTILITY PERNIITS <br /> Box GG (2750 Kelley Parkway) S�W�R/WATER ` �/ <br /> Crystal B�y, MN 55323 � ��, <br /> � <br /> „ <br /> GGNf:RAL INFORMATION � ��,`�� <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fees shown below. Permit cards will be sent by <br /> return mail tt�e same day tlle 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(473-7357)for utility stub as-built locations. DO NOT EXCAVATE <br /> IN ANY STREET AND DO NOT TAP ANY MAIN witl�out express approval of the Public Works <br /> Department. [ssuance 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 473-7357. <br /> 24 hour notice required. <br /> JOBSITEADDRESS: �C��`� �v9 �`C� �t�i�.%T� {�� <br /> Occupancy Type: )C Residential Commercial <br /> Owner's Name: I�vE_ ��,�,rK�= Plione Number: '�71 - (`��7�_� <br /> Mailing Address: �(o�5�-I <R �� ����v-r- r-�'�>. City: %Yz:��� t'-a �p: `�`� 3��i I <br /> Contractor's Name: � ��_ ���,��-5- (�, :�_,��� Phone Number: `;�1 -;��1 I <br /> MailiugAddeess: �{�U'�/.ciE57Z3ti <<c,�- City: l�L.`�/11u�fTi-F� 7�p: �5S,3�1 <br /> PERMIT TYP� <br /> Municipal Sewer Connectio�i ($35.00 per stub) $ <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 /> Muliicipal Water Connection ($35.00 per shib) $ �� ��J <br /> pipe size_� inches; material �< copper; odier <br /> WATER METERS 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 /> Watcr mctcrs niust be sct and sealed by Orono Watcr Dep�rtment(473-7357)upon completion <br /> of mctcr installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> REQUIR�D setback from sewer line =20' <br /> e <br /> P�RMIT FI:I�: 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 & 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 work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certif es that all statements made on this application are complete, true and correct. <br /> � - <br /> Signature of Applicant: �� '�1.�0 �� � � '�'``" � � Date: �� ��'- 9�� <br /> , <br />