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CITY OF ORONO APPLICATION FOR UTILITY PERiti1ITS <br /> t Box 66 (2750 Kelley Parkway) SE`VER/WATER <br /> Crystal Bay, MN 55323 <br /> GE�IERAL INFORMATION <br /> 1. 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 fees shown below. Permit cards will be sent <br /> by return mail the same day the application is :eceived. <br /> 3. Permits are not valid until you receive a pern►it card. <br /> 4. Work must not begin unless the pernut card is available on the job site. <br /> 5. Utiliry connection pernuts 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 STREET AND DO NOT TAP ANY MAIN without express approval of the Public �Vorks <br /> Department. Issuance of a pernut does not grant 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 473-7357. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: � - a�s c����y� <br /> Occupancy Type: 2/ Residential Commercial <br /> Owner's Na.-ne: � pL /�,64.vS'�� PhoneNumber: <br /> Mailing Address: ��� � �s'�"y/� _ City: 7ip: <br /> Contractor's Name: Gs��- ����"� PhoneNumber: ti.�� �u a�� <br /> Mailing Address: S'�,,p ���L, City: �� Zip:-�3'..? s'� <br /> PERMIT TYPE ,, <br /> Municipal Sewer Connection ($35.00 per stub) $ ��� _ <br /> pipe size _�ch�s; material�-� PVC (on sand fill); cast iron <br /> SAC Charge ($750.00) must accompany all sewer permit applications unless prepaid. If not <br /> prepaid, a sewer connection permit will not be issued. <br /> Municipal Water Connection ($35.00 per stub) $ <br /> pipe size inches; material copper; other <br /> �VATER METERS must be picked up and paid for at City Hall. <br /> (5/8" meters = $133.00; 3/4" meters = $181.00; 1" meters = $235.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department (473-735� upon <br /> completion of ineter installation. <br /> REQUIRED minunum setbacks from drainfield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <br /> PERMIT FEE CALCULATION <br /> � 1. Subtotal of above permit requested $ <br /> „���,, 2. State Surchar�e $ .50 <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 & Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ `s'� � <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to <br /> do all work in strict accordance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Signature of Applicant: ���� �-S� <br />