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t CITY OF ORONO APYLICATION FOR UTILIT�' PERM1'TS <br /> " I3ox GG (2750 Kelley Parkway) SEWER/WATER <br /> Cryst�l 13ay, MN 55323 <br /> GGNCRAL INFORMATION <br /> 1. You may apply for utility pennits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fces shown below. Permit cards will be sent by <br /> return mail the same day the application is received. <br /> 3. Permits�re not valid until you receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(473-7357)for utility stub as-built locations. DO NOT EXCAVATE <br /> IN ANY STRGET AND DO NOT TAP ANY MA1N without express approval of the Public Works <br /> Department. Issuance of a permit does not grant this approval. <br /> 7. All wo►•k must be done in accordance witli State Code requirements. <br /> 8. All work must be inspected before it is covered. Ca11473-7357. <br /> 24 I�our notice required. <br /> JOBSITEADDItCSS: �.. .1�- S � <br /> Occupancy Type: � Residenti�l Commercial <br /> Owncr's Namc: �� `. �.�. = �-� Phone Numbcr: y � 7� � �'(�' ; <br /> M�iling Address — City; 7�p. <br /> Contractor's Name: _ - PhoneNumbei•: yhrrl _��,� ���;— <br /> Mailing Address: � Clty' ��,� :2�: Zp• S,S��.�s — <br /> PERMIT TYPL <br /> Municipal Sewer Connection ($35.00 per stub) � $ <br /> pipe size�inches; material ��/ PVC (on sand fill); cast iron <br /> SAC Cl�arge($850.00)must accompany all sewer perinit applications unless prepaid. If not prepaid, <br /> a sewer connection permit will not be issued. <br /> Municipal W�tcr Connectiou ($35.00 per stub) $ �,�� <br /> pipe size inclies; material copper; otller <br /> WATLR ME"I'LRS must be picked up and paid for at City Hall. <br /> (5/8" meters = $139.00; 3/4" meters= $191.00; 1" meters = $247.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department(473-7357)upon completion <br /> of mctcr installation. <br /> REQUIRED minimucn setbacks froin draiiifield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <br /> PI;IZM[T FEC CALCULAT[ON <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .Sp <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each well, sewer and water connection permit requested. � <br /> 3. Posta�e & Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ <br /> The undersigned liereby applies to the City of Orono for issuance of a Utility Pennit, agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Mituiesota, and certifies that all statements made on this application are complete, true and correct. <br /> `, � � <br /> Si�nat��re of Applicanl: -��/.��%�����(/ Date: j '� ' ?�� <br />