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� 'CITY OF ORONO APPLICATION FOR U'i'ILI1'Y YL+'12M1'1'S <br /> Box 66 (2750 Kelley Parkway) S�WER/WATER r�/�l_,��z- <br /> Crystal I3ay, MN 55323 <br /> GCN�RAL INI+ORMATION <br /> I. 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 l�andling fees shown below. Permit cards will be sent <br /> by return mail the same day the application is received. <br /> 3. Permits are not valid untii 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 ANI) DO NOT TAP ANY MAIN withou[ 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 requiremerits. <br /> 8. All work must be inspected before it is covered. Call 473-7357. <br /> 24 hour notice required. <br /> r <br /> J�B SIT� E�D�SS: %�✓f , � _ <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: n�� PhoneNumber: y/l".�•- %�'��j _ <br /> Mailing Addr City: 7�p: � �, <br /> Contractor's Name• :�� PhoneNumber: �� -- �o e� <br /> Mailing Address: 3 ��_> � „� City: l,,� 7ap:_;�� <br /> l� . - <br /> PERMIT 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 pertnit applications unless prepaid. If not <br /> prepaid, a sewer connection permit will not be issued. <br /> Municipal Water Connection ($35.00 per stub) $ <br /> pipe size inches; material copper; odier <br /> WATER MET�RS must be picked up and paid for at City Hall. <br /> (5/S" meters = $133.00; 3/4" meters = $181.00; 1" meters = $235.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department (473-7357) upon <br /> completion of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <br /> PLRMIT FEE CALCULATION <br /> 1. Subtotal of above permit reyuested $ _ <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 & Handlin� (Only mail-in applications) $ 1.50 <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 <br /> do all work in strict accorciance with the ordinarices of the City and the regulations of the State <br /> of Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> � �_ <br /> . � � ` :�� /�Z � <br /> Signature of-Applicant• �. L�' _ I)ate <br />