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D�c-04-2001 12:44pm FroR-CITY OF ORONO +p6224o4616 T-1GT P.001/DO1 F-305 <br /> �v�+car�vu`is�rul) <br /> _ �CTTY OF ORONO A.PPLICATION FQR UTILITY PERNIITS <br /> Box 66(2750 Kclley P$rkway) B�WER/WATER <br /> Crystal Bay,hZN 55323 <br /> �ENE INFORMAT�ON <br /> l. You may spply for utility pennits by mail or u�persan atthe City offtces. <br /> 2, Mailed in applications are subject to the posta�ge snd han�ing fee showa below. Permn cerds will be sentby <br /> retua►mai!the same day the apptiastion is rea:ived. <br /> 3. Peemib are aot vslid until yon receeve a permit eard. <br /> 4, Wark must not beg�unless the permit card is avatlable on the job site. <br /> 5. Utility connxtion pctmits may be iss�ed to licens�d eontractors only. <br /> 6, Coatact the Public Works Departmcnt (952-249�600} for utility stub ag-buitt lxations. p0 NQT <br /> IXCAL'AT'E IN ANY STRE�'T A.'JD DO NGT TAP ANY MAIN withov�t express approval of thc Public <br /> WOa�ks DeparOaenL Lssuance of d permit does not�ant this approval. <br /> 7. AU wnric atust be done in aecord.�nca with St�o Code ro�uueu�onts. <br /> 8. AA wdrk meut be inspacted before it is covere+l, Cull(952)�49-4600. <br /> 24 hour notice req�ired. <br /> JQB SIT�ADDRTSS_��C�� �r1C t ,��c�c.c� ?�'Z��� <br /> Occup�acy Type: �c Residential Commercial <br /> Uwuer's Narnt:Tw;rlw�S�. 1Zs-�.r.d�,:--�.� y Phoae Number:��7�-'-+�►— 7:'/ b <br /> Mailin�Addee�s:l(c�°� C c,r�c�1�\�,r�.. ���-; City: C� ��,y-��, 7�=� <br /> Contractor'a Nam�: . �-� f � Pf,onc Namber-"�`��-�13-�--`7'11'"1 <br /> Maiiing Addrtss:l�=r�,��-z ..._.�� ' ,S &�:� City:�l\e���s-�-�+�1�;, T.�: ��V� <br /> P�RNIYT 7"I'PE <br /> Municipal Sewer Conncction (�35.4�por stub} $ <br /> 11���� pipe siae___�__inches; metcrial,,,�C,�Schedule 44 air tested; cast iron <br /> ''�"'� SAC Charge(200Q raie�I,15Q.�Ja�must acco�paa�all scwer pau�it applic�ons unless prepaid. <br /> �' �.ts If uat prepaid,a sewer c,�.x�-,�� ;��:-�it will�wt bt issu�d. <br /> l <br /> Municipal'NVAter Connection($35.00 per stub) � <br /> pipe siz,��inahes; material�,�copper; other <br /> WA?ER METERS must bc pick�:d up and pai�l for at City Hall. <br /> Water meters maat be aet aad seated by Clrono Water Depat�m�nt (9SZ-?,49-4600) apon <br /> completion of inetGr lnst�lbttion. <br /> REQtI�D minimum sctbac3cs from drain field and septic tauks=75' <br /> REQC7IRED setback$om sewcr line=2U' <br /> pEBMIT�FFE.c�.cuLATTON <br /> l. Subtotal of abovc permit rr�ucstcd $ <br /> 2. State Su�t��c $ .50 <br /> 'Ibc S�Buikding Codc Divisian Surcha►gc o�'S.S�per perrnit must be <br /> included for eao}�,well,sewer�nd watar conne<tion permit reqursted <br /> 3. post�ge&�andling(Orily mail-in apptications) � 1.50 <br /> 4. TOTA.L PERMIT FEE(ndd linAs 1-3 above) S <br /> Thc uadersi�ned heroby applics to the City of�hono for issuancx af a Utility Permi�agrxs to do <br /> all work ia slrict �xordnnce with thc ardinR,�ra of the City and the rtgulations of the State of <br /> Minncsota,and certifics thaL all statements rnadc on tlus e�plication are eompiete,m.ie and correct. <br /> Signatiue of Apptican�����Cl,��. f�Q��,�.1 Date: /�� ��. <br />