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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66_ (1335 So Brown Rd) SEWER WATER <br /> Crystal Bay, MN 55323 ��� <br /> *************************************************************************** <br /> I: You ma�yta ply�or utility permits by mail or in person at the City offices. <br /> 2. Mail-ed in applications are subject to the postage and handling fees shown below. <br /> Permit cards will be sent by return mail the sam� day the application is received. <br /> 3. Pe�u.ts are mt valid until you reoeive a pe.�ai.t 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 Departm�nt (473-7357) for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY SZREET AND DO NCyr TAP ANY M�N without express approval of the <br /> Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. A11 work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Cal 1 473-7357. <br /> 24 haur notic�e reqni r�. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: ��� � I�� u �4E�w �L' - <br /> Occupancy Type: �_Residen ial Commercial <br /> OWNER'S NAI�: (f �G� � �JG�� Phone No. : <br /> Mailing Address : City: <br /> // ,, �. � � y�'� - �/5�`7 <br /> CONTRACTOR'S NAML: � f� ' (,� -`fi�'` <br /> �,� f,�,� ry �= ��c��r � Bus. Phone• <br /> Mailing Address: CUS�%1 c.> . ,�� i5- City: Y�<<<n� Zip: ys;��/ <br /> *******************************************************�******************* <br /> P$RMIT TYPE AND FEE CALCIILATION <br /> MUNICIPAL SEWER CONNECTION ( $30 . 00 per stub) $ <br /> pipe size �_inches; material � PVC (on sand fill) ; cast iron <br /> SAC Charge ( $650.00 ) must accompany all sewer permit appl ci ations unless <br /> prepaid. If not prepaid, a sewer connection permit will not be issued. <br /> MIINICIPAL WATER CONNECTION ( $30. 00 per stub) $ <br /> pipe size � inches ; material �_ copper; other <br /> WATER METERS must be picked up and paid for at City Ha . <br /> (5/8" meters = $125 . 00 ; 3/4" meters = $163 . 00 ; 1" meters = $218 . 00 ) <br /> Water meters must be set and sea led by Orono Water Department (473-7357 ) <br /> upon completion of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75 ' <br /> REQL'IRED setL-dc:k from sewer line = 2G ' <br /> *************************************************************************** <br /> l . Subtotal of above permit requested $ <br /> 2. State Surcharge . 50 <br /> The State Building Code Division Surcharge of .50 per permit must e <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 /> ******************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, <br /> agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, an certifies that all statements made on this <br /> application are co�lete, true and oorre�t. <br /> Signature of Applicant: - i Date: ��-� �� c� � <br />