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(Updated 1/5/04) E <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER & SAC <br /> Crystal Bay, MN 55323 <br /> ,� <br /> GEl��ERAL INFOR'VIATION <br /> 1. You may apply for utility pemuts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee sho�m below. Peinut cards will be sent by return mail 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 pemut card is available on the job site. <br /> 5. Utility comiection pernuts may Ue issued to licensed contractors only. <br /> 6. �:-Eontact the Public Works Department(952-249-4600)for utility shiU as-built locations. DO NOT EXCAVATE IIvT ANY STREET AND <br /> DO NOT TAP ANY MAIN�vithout e�cpress approval of the Public Works Department. Issuance of a pemut does not grant this approval. <br /> 7. All work must be done in accordance witli State Code requirements. � <br /> �. All work must be inspected before it is covered. Call(9�2)249-4600,24 how-notice required. 4 <br /> JOB SITE ADDRESS: , (J �i � ' � ' � <br /> Occupancy Type: � ✓ Reside tial Commercial <br /> O��ner's Name:�;��,n� �f���� /�,�F�5� �� Phone Number: <br /> Mailing Add►-ess:�^ City: Zip: - <br /> Contractor's Name:��j�������.�,-Z- �c���.�-h nc.�. Phone Number: <br /> Mailiug Address: �-f�� �(� ,/Z��-3(p � City: � �i�� 7ip:rj5,3 -r'�- � <br /> PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One) <br /> SAC Cl�arge (2003 ►•ate $1,350.00) $ (Set Rate) <br /> Sac Charge must accompany al] sewer pennit applications unless prepaid. <br /> (If not pi•epaid, a sewer connection will not be issued) <br /> Municipal Se�ve�• C nnection/Disconnect/Repair (�35.00 per stub) $ <br /> pipe size�inches; material '✓" Schd 40 air tested; cast iron <br /> Municipal Water C.onnection/Disconnect/Re air ($35.00 per stub) $ <br /> pipe size �'--��� inches; material�opper; other <br /> � <br /> WATER METERS must be picked up and paid for at City Hall. <br /> Water meters must be set and se�led by Orono Water Department <br /> (952-249-4600) upon completion of ineter installation. _ <br /> REQUIRED minimum setbacks froin drain field and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <br /> PERMIT FEE CALCULATION <br /> 1. SuUtotal of above pennit requested $ <br /> 2. State Surcharae $ .50 (Minimtun) � <br /> , <br /> The State Building Code Division Surcharge of$.50 per pernut 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 /> accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements <br /> made on this applicatioi e complete, tiue and conect. <br /> Si��ature of Applicant: v � Date: -✓ � <br />