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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) - .SEWER/WATER <br /> Crystal Bay, MN 55323 <br /> GEl`�ERAL INFORMATION <br /> 1. You may apply for utility pemuts 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 received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the permit cazd 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 STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works <br /> Department. Issuance of a permit 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: �l � � r �'�� <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: , � PhoneNumber: �?�j--c� 7 / '� - <br /> Mailing Address: C, � � City: �l�,y�= 7�: <br /> Contractor's Name: � PhoneNumber: �1�--��3d <� — <br /> Mailing Address: �� > ��'` City: �,� Zp:�� <br /> PERIVIIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ <br /> pipe size inches; material �� PVC (on sand fill); cast iron <br /> SAC Charge ($800.00) 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 /> WATER 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 (473-7357) upon <br /> completion of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <br /> PERMIT FEE CALCULATION <br /> l. Subtotal of above permit requested � <br /> 2. State Surcharge $ .50 <br /> The State Building Code Division Surcharge of$.50 per pemut must be <br /> included for each well, sewer and water connection pernut requested. <br /> 3. Posta�e & Handlin� (Only mail-in applications) $ 1.50 <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 <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 /> ,�� <br /> Signature of Applicant�, ' ^ - �� `� � � <br /> (��Z� <br />