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(Updated 1/5/04) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Ke11ey Parkway) SEWER/WATER & SAC <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORNIATION <br /> L 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 fee shown belo�v. Pernut cards will be sent by rehirn mail the same day ' <br /> the application is received. ,;, �i+� <br /> ;� ; <br /> 3. Permits are not valid until��ou receive a permit card. (i,`� "`' (��`� - <br /> 4. Work must not begin unless the peinut card is available on the job site. �I� [ r; �1 �� <br /> 5. Utili ty coivlection pernuts ma y Ue issued to licensed contractors onl y. � C <br /> 6. Contact the Public Works Departmevt(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND ': <br /> DO NOT TAP ANY VIAIN without express approval of the Public Works Deparhnent. Issuance of a pernut does not grant this approval. ` <br /> 7. All�vork 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 required. <br /> JOB SITE ADDRESS: '��'1� �%�� `�C-� ��,' <br /> Occupancy Type: � Residential Commercial <br /> Owner's Name: � �l���;.,u� �„ S Phone Number: <br /> Mailing Address: _ City: � Zip: � <br /> Contractor's N1me: ��-; ,,,�'� 5�/�� Phone Number: �5.� � �f7-�- yS5-j <br /> Mailing Address: (���( � . ,�- _ ��� City: ;�c.�-�-,cj Zlp: S`��� �/ <br /> PERMIT TYPE �omlections ❑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 prepaid, a sewer connection will not be issued) <br /> Municipal Sewer nection/Disconnect/Re air ($35.00 per stub) $ <br /> pipe size inches; material ��chd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect/Re air (�35.00 per stub) $ <br /> pipe size ,�— inches; material�opper; other <br /> WATER METERS nrust be picked up and paid for at City Hall. <br /> Water 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 tanlcs = 75' <br /> REQUIRED setback froin sewer line= 20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above pennit requested $ <br /> 2. State SurcharQe $ .50 (Minimum) <br /> The State Building Code Division Surcliarge of$.50 per pernut must be <br /> included for each well,sewer and water connection pennit requested. <br /> 3. Postage & Handlin� (Only mail-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 Minnesota, and certifies that all statements ; <br /> made on this application are complete, true and correc <br /> , <br /> Signature of Applicant: ' Date: ����/ <br />