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- � C1T'Y OF ORONO APPLICATION FOR U'TILITY F�RMiTS <br /> l�ox GG (2750 Kclley Parkway) S�WEIZ'�dA'I'ER <br /> Crystal 13ay, MN 55323 <br /> GGNI;I2AL IN�ORMATION <br /> I. You n�ay apply I'or ulilily permits by m�il or in person at lhe City otliccs. <br /> 2. Mailed in applications are subject to the pustage and handling fees shown below. Pennit cards will be sent by <br /> relurn mail the same day the application is received. <br /> 3. Permits are not v�lid until you receive a permit c1rd. <br /> 4. Work must not begin unless the permit card is availabfe on the job site. <br /> 5. Utility connection pennits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(473-7357)Sor utility stub as-built locations. DO NOT'EXCAVATE <br /> IN ANY S'i'REET 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 witl� State Cade requirements. <br /> 8. All work must be inspected before it is covered. Call 473-7357. <br /> 24 hour noticc required. <br /> JOI3SITEADDRESS:�4� j'1��,���1-J�/�/1---� � <br /> Occupancy Typc: � Residential Commercial <br /> Owiicr's Nainc: � � � �2«�-� YhoiicNuinber: <br /> Mailing Addre 3 � -��,�-• /�..�-r- City: �: <br /> Contractor's Na�ne: , _ Phone Numbe.r: ��y�y -i�� ys — <br /> Mailing Address: .�/�i City:-«��tiL-- 7�p. ���75 — <br /> Y�RMIT TYI'F <br /> li�lunicipal Se�ver Connection ($35.00 per stub) $ <br /> pipe size_�__ir�cl�ies; material � PVC (on sand fill); cast iron <br /> SAC Cliarge($85U.00)inust accornpany all se��er permit applications tulless prepaid. lf not prepaid, <br /> a sewer connection perinit will not be issued. <br /> l�'Iuiiicipal �V�ter �(:onnection ($35.00 per stub) $ <br /> pipe size__inches; material copper; other_ <br /> WA"1'ER Ml-;"1'LRS must be picked up and paid for at City I-�all. <br /> (5/8" meters = $139.OU; 3/4" meters = $191.00; 1" meters= $247.00) <br /> Separatc Plumbing Pertnit issued for water meter. <br /> V1'atci-meters must be set and sealcd by Orono�Vater 1)eparha��nt(473-7357) upon coanpletion <br /> of mctcr installation. <br /> R�(�UIR1;D minimum setbacks from drainCield and septic tanks = 75' <br /> RLQUIRLD setback fro�n sewer ]ine = 20' <br /> PF.RMIT FEI�, CALCULATION <br /> 1. Subtolal of above permit requesled $ <br /> 2. State 5urchar�e $ .50 <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each well, sewer and water connection pern�it requested. <br /> 3. PostaQe & I-Iandling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT F�� (add lines 1-3 above) $ <br /> The undersigned hereby 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 /> Minnesota, and certifies that all statements made on this application are complete, true and correct. <br /> � <br /> , <br /> Signalure oCApplic�u�l:_ _���/ ��„y�'�_ Date: �—3 - j� <br />