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(U;::iated 2/12/O1) <br /> � CITY OF ORONO APPLICATION FOR UTILITY PER�VIITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal 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 <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 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 (952-249-4600) for utility stub as-built locations. DO NOT <br /> EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public <br /> 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: ; �Z� �G YI �t..� S PT � �=--' <br /> ,�:' Occupancy Type: � Residential Commercial <br /> � <br /> � ' Owner's Name: �,��- � %v /'.� ��c��� Phone Ny}mber: %S Z--�`i�%- C�c�� <br /> :� , <br /> ailing Address: � ` �r„�. �: �_ City:/f/i ti��� ,r/�r Zip: 73-�G.S- <br /> (�� ontractor'sName: � —.�, 2,, �;'>,- v•�- �.z� -•-� PhoneNumber: G-i� `»�%�?S��/ <br /> , �-�' ailing Address: �%'c' �� ,� /S f ��'� City: ic�%�i1=�J9 �• S��`/ <br /> % ��'� � PERiVIIT TYPE . <br /> ��' �� cipal Sewer Connection ($35.00 per stub) $ <br /> " ��- pipe size inches; material Schedule 40 air tested; cast iron <br /> �-� ��SAC Charge (2000 rate $1,150.00) must accompany all sewer permit applications unless prepaid. <br /> `� If not prepaid, a sewer connection permit will not be issued. <br /> ^,� <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 (9�2-249-4600) upon <br /> completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks= 75' <br /> REQUIRED setback from sewer line= 20' <br /> PERIVIIT FEE CALCULATION � <br /> 1. Subtotal of above permit requested $ <br /> 2. State SurcharQe $ .50 <br /> The State Building Code Division Surchar?e 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 PERNIIT FEE (add lines 1-3 above) $ <br /> The undersi�ned 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 /> � - - --- ---- . � <br /> r" <br /> . _ � l�- � i <br /> Signature of Appli Date: l <br />