Laserfiche WebLink
� ' C1TY Ur O1tON0 APPLICATION FOR UTII,ITY YEKMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Cryst�l Bay, MN 55323 <br /> GENERAL INP'ORMAT[ON <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 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 pennit card is available o�i 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 NO't TAP ANY MAIN without express approval of the Public Works <br /> Departme►it. Issuance of a permit does not grant this approval. <br /> 7. nll work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Ca11473-7357. <br /> 24 hour notice required. <br /> J013SITCAllllIZ�SS: �� � � C�'¢5^C—U ��C �„�U� 1l � <br /> Occupancy Type: Residenhal Commercial <br /> O�vner's Name: Phone Number: <br /> M�iling Address: City: 7ip: <br /> Contractor's Name:,,/(/ ,�_�,.�1��0�/ PhoneNumber:�� ��ZC�C� <br /> y <br /> Mailing Address:��f� �,� 7_�.`hn �; 7` City:� .c>l s'�-� 7�p: ;����L�6�' <br /> PEItMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ <br /> pipe size inches; material PVC (on sand fill); cast iron <br /> SAC Charge($850.00)must accompany all sewer perrnit applications unless prepaid. If not prepaid, <br /> a sewer connection permit will not be issued. <br /> � <br /> Municipal Water Connection ($35.00 per stub) $ <br /> pipe size _inches; material copper; other <br /> WA'I ER �"� � -mti��b6-�ic•�c�d up and paid for at City Hall. . <br /> 5/8" ineters = $135.00; 3/4" meters = $185.00; 1" meters= $240.00) <br /> Separate P urn ing ermit issued for water meter. <br /> Water metcrs must be set and sealed by Orono Water Department(473-7357)upon completion <br /> of inetcr installation. <br /> REQUIRED rninimum setbacks from drainfield and septic tanks= 75' <br /> REQUIRED setback from sewer line=20' � <br /> PERMIT FC� 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 perniit requested. ` <br /> 3. Posta�;e & Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT P�E (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 certilies lhat all statements made on this application are coinplete, true and correct. <br /> ` / `� <br /> Signature of Applicant: � Date:� � C �, <br />