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(Updated 6/2/03) <br /> CIT�'�OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay, MN 55323 <br /> �, <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pernuts by mail or in person at the City offices. E <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will be sent by rehun 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 pernut card is available on the job site. <br /> 5. Utility connection pernuts may be 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 Public Works Department. Issuance of a pemut does not gzant 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. Call(952)249-4600,24 hour notice required. <br /> JOB SITE ADDRESS: (���� i�i'4��� ��� (��;�.�� ��c�._ <br /> Occupancy Type: }� Residential Commercial <br /> Owner's Name: Phone Number: <br /> Mailing Address: City: Zip: <br /> Contractor's Name: ����f��,�� c f�..i Phone Number: �5'��.z) �f 7� _c:���E <br /> Mailing Address: �S �/ l�', jl�. r`� City: ����.�,,� Zip: S—` -: � <br /> PERNIIT TYPE ❑Connections ❑Repairs �Disconnect (Check One) <br /> SAC Charge (2003 rate $1,275.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> �___'..� <br /> Municipal Sewer Connection7�isc-�.pne epair ($35.00 per stub) $ <br /> pipe size inches; material Schd 40 air tested; cast iron <br /> Municipal Water Connect�n�Disconnect/Repair ($35.00 per stub) $ <br /> pipe size in,:�ies; material copper; other <br /> WATER METERS must 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 tanks = 75' <br /> REQUIRED setback from sewer line =20' <br /> PERI�IIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 (Minimum) � <br /> The State Building Code Division Surcharge of$.50 per pemut must be <br /> included for each well,sewer and water connection permit requested. � <br /> 3. Posta�e &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 correct � <br /> Signature of Applicant: Date: / � �',� <br />