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CITY OF ORONO � ^ APPLICATION FOR UTILZTY PERMITS <br /> Box 66 (1335 So Brown Rd) SE�TER F�'AT�R <br /> Crystal Bay, MN 55323 <br /> *k***�k**�k�t*ic**********�t***�t*�t***�F*�k**�k�lr*�kic�k**�k�k***�c**ic�k�k�k�c**�t�k**ir****�Y�k�k�k�c�t <br /> I:-You ma�ply�or 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. <br /> Permit cards will be sent by return mail the same day the application is received. <br /> 3. P�its are n�t valid imtil you reoeive a permit c�.rd. <br /> 4. Work must �ot 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 Depas�tme,nt (473-7357) for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STRE�.'T AND DO NCYr TAP ANY MAII�7 without express approval of t�e <br /> Public Works Depas-�ment. Issuanoe of a permit does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. Al 1 work must be inspected before it is oovered. Call 473-7357. <br /> 24 haur no�t.iae required- <br /> *************************************************************************** <br /> JOB SITE ADDRESS: .� � �' r �" �- � � �'� <br /> Occupancy Type: Residential Commercial <br /> OWNER'S NAME: JA v h r � Phone No. : <br /> Mailing Address: 5�a /j.� r�^ �C /� ✓e- City: Oroi►/o <br /> CONTRACTOR'S NAI�R�: ��vM �j ,`Nq se �^ �� c e,s' �n/�, Bus. Phone: 7��� yo �0 <br /> Mailing Address: ( �. 9' �,'y ! r✓ •�y /e City: �1�/5 Zip: Sj'�3�, <br /> *************************************************************************** <br /> - P$RMIT TYPE AND FES CALCIII,ATION <br /> MIINICIPAL SEWER CONNECTION ( $30. 00 per stub) $ <br /> pipe size inches ; material PVC (on sand fill) ; cast iron <br /> SAC Charge ( $700.00 ) must accompany all sewer permit applications unless <br /> prepaid. If not prepaid , a sewer connection permit will not be issued. <br /> MIINICIPAL WATER CONNECTION ($30. 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 = $133. 00; 3/4" meters = $181. 00; 1" meters = $235. 00) <br /> Water meters must be set and sealed by Orono Water Department (473-7357) <br /> upon completion of ineter installation. <br /> ` REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20 ' <br /> *************************************************************************** <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surcharge . 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 PERHIIT FEE (add lines 1-3 above) $ <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, <br /> agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this <br /> application are co�lete, true and correct. <br /> Signature of Applicant: ����'�� �� �-�- Date: ��� � � c1� <br /> �Q-z� .Q�c�� ��� ��G�- '�`� <br /> /�� 'P �����-r� Dti�.�z'`'' � --�-��--e- <br /> �� <br />