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CITY OF ORONO APPLICATION FOR UTILIT�'PERlO�IITS <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 fees shown below. Permit cards will be sent by <br /> retum 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. Utiliry connection pernuts 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 /> Departrnent. 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 /> t <br /> ` � �� -�� _ � .� -} <br /> �, S � •� ;d,� .5 --; ;;'�' �_c,+ � <br /> JOB SITE ADDRESS: i .� l��n {'�� <br /> Occupancy Type: tr,,� Residential Commercial <br /> Owner's Name: Phone Number: <br /> Mailing Address: City: 7�p: <br /> Contractor's Name: �, `L�S ��:�,-+ ,'% �.--- Phone Number: y 7� y t S�� <br /> , <br /> Mailing Address: �;5".�,i Cc� ,2c�. j�� City: .�c.�.-,�+ 7ap: �5�L�/ <br /> S <br /> PERMIT TYPE .. c���� <br /> Municipal Sewer onnection ($35.00 per stub $ l�-'�-' <br /> pipe size�inches; material ��,. Schedule 40 air tested; cast iron <br /> � <br /> SAC Charge ($1,050.00) must accompany all sewer permit 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; other � <br /> WATER METERS must be picked up and paid for at City Hall. <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 must 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. �j <br /> 3. Postage & Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERNIIT 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 q.f-the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made-�ri this application are complete, true and correct. <br /> ,� <br /> :if <br /> � � '. <br /> .�---:-� ;. �� � �, � <br /> , <br /> Signature of Arrlicant: �' -----� Date: <br /> / <br /> f <br /> I <br /> 1 <br /> � � <br />