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Sop-04-2003 01:17pm From-CITY OF ORONO +g622494616 T-�9S P.001 P-783 <br /> L � <br /> CITY O�'41tO�T0 Al'��.ICATION'FOR UTILYT'Y Pfi� T3 L��l 1 <br /> ' SEWER!'WATER � –> ��� <br /> Box 66{275U Ke11ey Parkway) r�= � <br /> � Cry�t�al Bay,lY1N 55323 � �,����� ��� �� <br /> . �P ��� �p , <br /> GENERAL�N�(3RMATION <br /> 1. You may Fspply for utiIity permits by mail or in pe�aon at tha City offces. <br /> 2, Mailed in applic�tions arr;subject to the postage snd handling fee show+n below. Permit c wi sent b}•return mail thc sa�►e da� <br /> the epplicatian is received, <br /> 3. Fermits are not valld until you receive a permit card. <br /> 4. Wark must not bcgin unla;ss the permic card is availabte on the job site. <br /> 5. Utility connection permix�rasy be lssued to licensed contractors on�y. <br /> 6. Contact the Public'Works Departrnent{952-249�604)for utiliCy stub as-built locationa. DO Nt�T BXCAVATE II�1'ANY STREET AAC� <br /> �}(�NOT TAP ANY MA]N witliout expresa appmval o�the Publlc Warks Departinent. Issuance of a perniit doos not�rarit this approva� <br /> 7. All work rnust be dene i�t accordance with Scate Code requirements, <br /> 8. A31 work must be inspectcd before it is cavered. Call(952)249-4600. <br /> 14 hour Aotice reqalred. ` <br /> JO� SIT�ADDRESS: �(�,�-� �'��'�.�� l�F''I����� �'—�-/ <br /> Occupstncy Type: ✓ 17esidential �0�¢0rcial <br /> 4w�er's Name:_ � � y � Phane 1 umber: `7 5��;= ,�_�2=�3� � <br /> M�iliu�Addres�: Z c._F__ �i rr_�t ,,,,,_ City:6� ��� -- ZiA: �S `� 3`�/ <br /> Cantractor's Ns�me: S-�CCA.c��tiJl--� �� Phone�iu : �=-� ��' �� �'c.�S� <br /> Mailing Addrtss:- `�������z', /L` — City:���E Zip: –r -.�.�' <br /> ,'J� � <br /> PERMY'T T_I'pE <br /> Manicipal Sewer Connecti�on($35.a0 per stub) � •=�F�� r� <br /> pipe siza inchf;s; material Schedulc 4�air tested; cast iron <br /> SAC Char�e(2Q02 rate$1,20Q.00)must accompany all sewer permit applications unless prepaitf. If not prepaid,a sewe: <br /> connection permii vvili nat be issued. <br /> Municipal Vt'ater Connectioa($35.00 per stub} � -��� �� <br /> pipe size i�ch��s; znatcrial copper; other <br /> WATER METERS must be•picked up and paid far at City F�a11. <br /> Water metcra must be set and sealed by Oxano Water Department (952�249-4600) upon completion �f inete� <br /> installation. <br /> ItEQUIRET)minirnum setibacks from drain field Rnd septic tanks=�5' <br /> �tEQUIREl� setba�lc from se�uvcr linc�20' � , <br /> E C LATIOlY <br /> 1. Subtotal of above pertnit requasted $ .��- C`�' <br /> 2. State SurFhar�� � -�— <br /> The Stats Huifdirsg Cade Division Surcharge of S.SO per permit must be <br /> iricluded for each well,szwer and water cannection permit requessed. <br /> 3, pastage&T�andli��(Only mail-in applications) $ �� <br /> .4, 'fQT',4r,PERMXT FFE (add lines 1-3 above) $ �C`',�-�L` <br /> Thc undersisned h�reby ap��lies t� the City of Orana for issuanc� of a U'tility Ptignit, agrees to do ali work in stric <br /> accordar:cc with the ordinances of the City and the regulations of the Stare of Minnesota,and c�rtifics that all statement <br /> made on this application arc complete,true and eorrect. <br /> Si�nature of APplicant: '' � T�ate: � ��--� <br />