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(IIpdated 2/12/O1) <br /> CITY OF.ORONO APPLICATION FOR UTILITY PERMITS <br /> Bo1:'66 (2750 Kelley Parkway) SEWER/WATER <br /> Ciystal Bay, MN 55323 <br /> GENERAL INFORMATION <br /> 1. 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 handling fee shown below. Permit 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 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 Deparhnent(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND � <br /> DO NOT TAP ANY MAIN without express approval of the Public Works 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(952)249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: j ��� ,�O�-.!dJ S �D i NT �O��j <br /> Occupancy Type: �Residential Commercial <br /> Owner's Name: �L,��J �y �;l;`,�! G�r��l�' Phone Number: <br /> Mailing Address: ��ZA "�:�.a�S �; l�lj• City:�����R.�'� Zip: � 4 <br /> Contractor's Name: N,�vt 't�LJY=1�j j•1��. Phone Number: y5�yZ�-��,��r <br /> Mailing Address: 3�c�' ��,p R}��,�''� �V13 City: ��t.' �.-6i�r z� Zip: �'��'y'Z� <br /> ���� <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ ��,+ � <br /> pipe size�inches; material� Schedule 40 air tested; cast iron <br /> SAC Charge (2002 rate $1,200.00) must accompany all sewer permit applications unless prepaid. If not prepaid, a sewer <br /> connection 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 /> Water meters must be set and sealed by Orono Water Department (952-249-4600) upon completion of ineter : <br /> installation. <br /> REQUIRED minimum setbacks from drain field 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. Posta�e & Handlin� (Only mail-in applications) $ �9- <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ 3 �;: ,�c <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 application are complete, true and correct. <br /> ��� � � J , , <br /> Signature of Applicant: C�.'�it,.�. i���-��� Date: � /� OZ <br /> �//���y <br />