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� CITY Or ORONO APPLICATION FOR UTILITY PERI�II'TS <br /> t Box G6 (2750 Kelley Parkway) S�W�R/WATER <br /> Crysta113�y, MN 55323 .�.���� <br /> � <br /> GGNGRAL INFORMATION <br /> l. You may apply for utility permits by mail or in person at the 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 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 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 State Code requirements. <br /> 8. All work must be inspected before it is covered. Call 473-7357. <br /> 24 hour notice required. <br /> JOBSITEADDRESS: � gs� <br /> Occup.incy Typc: �/' Rcsidcnti:� Commerci:�l � <br /> O�vner's Name: �-,r�J J�. h�� 5�.-, Phone Number: <br /> Mailing Address: City: 7�• <br /> Contractor's Name: ��y������{l� ���,�,�,b�;-,y �-�-,C PhoneNumber: 5 3�;- �;�7 <br /> M�iling Addi•ess: �yc��J,,,.,t 7/*.� /'�-e n.�- City: ���:�/�/y"f?,�k 7�p•_s�y��g <br /> P�RMIT TYP� <br /> Municipal Sewer Connectiou ($35.00 per stub) $ 3�. v O <br /> pipe size �-{ inches; materialse.h��/�' PVC (on sand fill); cast iron <br /> SAC Charge($850.00)must accompany all sewer pennit applications unless prepaid. If not prepaid, <br /> a se�ver connection permit will not be issued. <br /> Municipal Water Connection ($35.00 per stub) $ <br /> pipe size inches; material copper; odler <br /> WATLR MrTERS 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�tcr mctcrs must be set and sealed by Orono�Vatcr Dcp�rtment(473-7357)upon complction <br /> of ineter inst�►ll�tion. <br /> REQUIRED miniinum setbacks from drainfield and septic tanks = 75' <br /> IZEQUIRED setback from sewer line= 20' <br /> P�RMIT FF,P; CALCULATION <br /> 1. Subtotal of above permit requested $ 3 S �o <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 & Handline (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ �' 7. aa <br /> The undersigned liereby applies to the City of Orono for issuance of a Utility Pernlit, 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 al statements made on this application are complete, true and correct. <br /> , � <br /> � <br /> Signature of Applicant: /l��C'�-G'�- Date: /�- �� 9� <br />