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(Updated 1/5/04) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box `(2750 Kelley Parkway) SEWER/WATER & SAC <br /> �rystal Bay, MN 55323 � <br /> GENERAL 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 fee shown below. Permit cards will be sent by return 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 Deparhnent. 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(952)249-4600, 24 hour notice required. <br /> JOB SITE ADDRESS: �1� � +�{J/ G�' l'. '�''� G � ` <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: 'C�� ,,� Phone Number: <br /> Mailing Address: � o� �.t S ,c w 1,'j,, City: Zi : <br /> Contractor's Name: r z o �,,���+ �- �- Phone u ber: �'� �2 G "'— a a� <br /> MailingAddress: �/�"!1 �"yrhG � City: ; Zip: � <br /> PERMIT TYPE Connections � <br /> � ❑Repairs ❑Discoruiect (Check One) <br /> SAC Charge (2003 rate $1,350.00) $ (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 /> � �Municipal Sewer onnection/Disconnect/Repair ($35.00 per stub) $ � r <br /> pipe size inches; material 'C- Schd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect/Repair ($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 /> 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 /> REQUTRED setback from sewer line= 20' <br /> PERMIT 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 pernut must be <br /> included for each well, sewer and water connection permit requested. <br /> 3. Postage &Handling (Only mail-in applications) $ 1.50 (Mail In Only) <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ <br /> The undersigned hereby applies o the City of Orono for issuance of a Utility Permit, agrees to do all work in strict <br /> accordance with the ordinance of he City an the regulations of the State of Minnesota, and certifies that all statements <br /> made on this application are m lete, t a d correct. <br /> � <br /> Signature of Applicant: Date: (� <br />