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. �. <br /> (Updated 1/5/04) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER & SAC <br /> Crystal Bay, MN 55323 <br /> GE\ERAL INFORMATION <br /> L You may apply for utility pernvts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and haudling fee sho��i below. Pemut cards will be sent by retuni inail the same day <br /> the application is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the penlut card is available on the job site. <br /> 5. Utility comiection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility snib as-built locations. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a pemut does not grant this approval. <br /> 7. All work nuist be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600, 24 houi-notice required. <br /> JOB SITE ADDRESS: .��'lS� �-��f�v �% �'�'��� <br /> Occupancy Type: � Residential Commercial <br /> Owner's Name: '� � /1-•>�����/'✓ Phone Number• �� -���'�� ' :����—'� <br /> i�=-- <br /> Mailing Address: City: Zip: <br /> Contractor's Name: Gc.=!�1,��� �-�,��;,z..�„.,,,. `;�c� Phone Numbei: y.s� %:s�-`s�rl� . <br /> Mailiug Address: �y.�s�" �lz�l<< /-�"- City;��.f�s�"���<� 7ip: .�s=�.s� <br /> PERMIT TYPE ��'�oiinections ❑Repairs ❑Disconnect (Checic One) <br /> SAC Cliarge (2003 rate $1,350.00) � (Set Rate) <br /> Sac Ch.arge must accoinpany al] sewer pet7nit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Muuicip�l Sewer Connection/Disconnect/Repair ($35.00 per st���., �. <br /> pipe size_�iuches; inaterial /�hd 40 air tested; �ast iron <br /> Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $ <br /> pipe size� inches; material�opper; other <br /> WATER METERS nnist be picked up and paid for at City Hall. <br /> Wate►• meters must be set and sealed by Orono Water Department <br /> (952-249-4600) upon completion of ineter installation. <br /> REQUIRED minimum setbacics from drain field and septic tanlcs = 7S <br /> REQUIRED setback from sewer line = 20' <br /> PERMIT FEE CALCULATION <br /> 1. SuUtotal of above pernlit requested $ <br /> 2. State Surchar�e $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per perntit must be <br /> included for each well,sewer and water connection pernut requested. <br /> 3. Posta�e &Handlin� (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 work in strict <br /> accardance with the ordinances of the City and the regulations of the State of Mim�esota, and certifies that all statements <br /> made on this application are complete, true and correct. <br /> Si�ature of Applicant � L/�—�-�.�--� Date: ��:l-:i,/ <br />