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` D�c-04-2001 12:44pm Frort,{ITY OF ORONO �G622404616 T-2G7 P.001/001 f-305 <br /> �U�+U7llO{I(r114IV1) <br /> CITY OF ORONO A.PPLICA'Y'TQN FOR UTILITY PERMITS <br /> Box 66(2750 KcUey Parkway) SEWEI2/WATER <br /> Crysta!Bay,IIZN SS323 <br /> GENE L INFORMAT�ON <br /> l. You may t�p?y for utility pertnits by mai]ar i�i person atthe City offices. <br /> 2, Mailed in Applications are aubject to the postage afld handlins fee shown below. Permit cards will be sent by <br /> return mail tba same day the appli�ation is rec�:ived. <br /> 3. Permit�are oot valid until yon reaive a petmit eard. <br /> 4. 'GVork must not be�m unless the permit card ia availBble on the job site, <br /> S. Utility connxtian pamits may be issued to licensed cantractors only. <br /> 6. Contact the Public Works Department (952-249�600) for uu'lity stub aq-built locations. p4 NOT <br /> IXCAVAT'E IN ANY STREE7'A.�TD DO NC�T TAP ANY MAIN withont exprrss approval of dse Public <br /> Works Depart�uen� issuence of a permit doee not�zu►t this app�oval. <br /> 7. AU wark mus!be donc in accordance with Stauo Code rec,uirements. <br /> . 8, Ail wdrk mti+t be iaspacxed before it is covere�l. Cull(952)Z49-4600. <br /> � •J � S— 2A hour nalice req�ired. <br /> � <br /> J48 SI�'�ADDRTSS_ ����� ��i�C�'Y-<< � o�. ��r� <br /> Oecupaacy T�pe: x� Y'ctsidentiai CommerciaP <br /> Owuer'�Niuue• � '\� Phone Number: <br /> �111A�1�i��rE39:� 4b�.�-�s�� t�t-��i n_ `•�' ' �.1�': >( �K11 .. � <br /> Contractor'a Name: � 1�- P6oa�Numbe�:�'i5�-°►�� <br /> Mailing Address: �.=��a City: (Y�-t-�,y., T�:�3�,1,� <br /> P��MTT TYPE <br /> �.l� �Vduaicipal Sewer C nacction (S35A0 per s�b} $ ��,C��� <br /> 1J�` pipe size�:nches; matcrial„�Schedule 40 eir tested; cast iron <br /> �'� SAC Charge(200Q rate$1,150.00)must acco�nzpan�aIl sewer painit applications unless prepaid <br /> �+ f If uot prepaid,a sew�er connection peruut will�wt be issia�d. <br /> Municipal'1�Ater Conoection($35.00 per stub) � '?�'-� .c�. <br /> pipe aize � inahes; material�„�copptr; other <br /> WATER METERS must bc picked up and pai�!for at City Hall. <br /> Water meters ntast be act and sealed by (lrono Water Depatfincnt (952-?A9-4600) apon <br /> completion of inettr Lusb�lbttioa. <br /> REQL7YRE]a minimum sctbacks fi-om drain field and septic�=75' <br /> REQUYR�sctbeck$om sew�r line=�0' <br /> p..�',$MII'�',FE CALCULATION <br /> l. 9abtotal of above peruut requested $ � �j, (k � <br /> 2. Statc Sur�hsts�e $ .50 <br /> The State Building Codc bivision 5urchargc oi'S.SO per permit must be <br /> inctuded for aaoh well,sewer and wator conne�tion permit requ�sted. <br /> 3. postage&�andling(Only mail-in applications) � �� <br /> 4. TOTAL PERNIIT FEE(ndd linos 1-3 above) � �� ,�-�„� <br /> Tbc undersigned hereby applics to the City of ihono for issuance of n Utility Permit,agr�s to do <br /> all work in StriCt aCCordtfttte with thc ord+_nAn,rs of the City and the regularions of thr. 4tate of <br /> Minncsota,and eertifies that all statements madc on this applicarion are complete,�ue e�r��°�srrect. <br /> Signat�ue of Applicat��,`�-T.� ��^��'� Date� //- �`�0��_, <br />