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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> , Bog 66 (2750 Kelley Parkway) SEWER/WATER <br /> � Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <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 fees shown below. Pernut 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 pernut card is available on the job site. <br /> 5. Utility connection pemuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(249-4600)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. Ca11249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: � ''��� S��'^-��S �.�, I� . <br /> Occupancy Type: �_Residential Commercial <br /> Owner's Name: �)%�F} PhoneNumber: ��� <br /> Mailing Address: S-z.c_ ���,�.si. City: 7ap: <br /> Contractor's Name:'���wtp�'�c v� (��b�s- • Phone Number: �3 3-�2�t � 7 <br /> Mailing Address: j5c,c�r�(vt-�, �`.�.1 , (3 t.�� City: �-E-1��, 7ap: 5s3 s�r ,� <br /> ti <br /> PERMIT TYPE ')-� <br /> Municipal Sewer Connection ($35.00 per stub) $�'�� `'`' 1 <br /> pipe size �` inches; material Schedule 40 air tested; cast iron <br /> SAC Charge ($1,050.�00) must accompany all sewer pernut applications unless prepaid. If not <br /> prepaid, a sewer connec�'ion permit will not be issued. � <br /> Municipal Water Connection ($35.00 per stub) $ <br /> ,;�� pipe size inches; material copper; other • <br /> WATER METERS must be picked up and paid for at City Hall. . <br /> - - ----�--,---� <br /> --- ___ <br /> (5/8" meters= $130.00; 3/4" meters= $180.00; �1" meters= $240.00) � <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters mus�be set and sealed by Orono Water Department(249-4600) upon completion <br /> of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks= 75' <br /> REQUIRED setback from sewer line=20' <br /> PERMIT FEE 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 permit requested. <br /> 3. Postage &Handling (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 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 all statements made on this application are complete, true and conect. <br /> Signature of Applicant: Date: '}'� <br /> �ti <br /> 1 <br />