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(Updated 1/5/04) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER & SAC <br /> Cryscal ��y, MN 55323 <br /> GENERAL INFOR�VIATION <br /> l. You may apply for utility pernuts by mail or in persov at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown belo�v. Pemut cards will be sent by return mail the same day <br /> the application is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the pemut card is available on the job site. <br /> 5. Utility connection pernuts may Ue issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the PuUlic Works Deparmlent. Issuance of a pemut does not grant this approval. <br /> 7. All work must be done in accordauce with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600, 24 hour notice rec�uired. jJ(� <br /> i <br /> JOB SITE ADDRESS: � �� ��YL'�� ��. �v � �1�, � " <br /> Occupancy Type: � Residential Commercial '; �� <br /> Owner's Name:�`��j ,.����r�„� ((-�.�.c,s' Phone Number: <br /> Mailing Address: City: --� Zi�: <br /> Contractor's Name: ����,����,� Phone Number: ��S�? �f 7-t- ��� <br /> Mailing Address: �S� �a. �� �5 City: �c%��� , Zip: S3-3G " <br /> PERMIT TYPE �Coiuiections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,350.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer pennit applications unless prepaid. <br /> (If not p►•epaid, � sewer connection will not be issued) <br /> Municipa( Sewer Connection/Disconnect/Repair ($35.00 per stub) $ <br /> pipe size�inches; material�Schd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect/Repair($35.00 per stub) $ <br /> pipe size�inches; material�copper; other <br /> WATER METERS niust be picked up and paid for at City Hall. <br /> W�ter meters must be set and sealed by Orono Water Department <br /> (952-249-4600) upon completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks =75' <br /> REQUIRED setback from sewer line = 20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above pei7nit requested $ <br /> 2. State Surcharae $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per pernut must be <br /> iucluded for each well,sewer and water connection permit requested. <br /> 3. Postage & Handlin� (Only inail-in applications) $ 1.50 (Mail In Only) <br /> 4. TOTAL PERMIT 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 all work in strict <br /> accordance with the ordinances of the City and the regulations of the State of Mimiesota, and certifies that all statements <br /> made on this application are complete, true and correct. <br /> Signature of Applicant: � Date: �--2� - �`� <br />