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.. • (Updated 6/2/03) <br /> CITY OF OROl\'O APPLICATION FOR UTILITY PERMITS <br /> BoY 66 (27�0 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Ba�•, N1N �5323 <br /> GENERAI.L�FORtiiATION <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 fee shown below. Pemut cards will be sent by retum mail the same day <br /> the application is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> -�. Work must not begin unless the pernut card is available on the job site. <br /> 5. Utility connecrion pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locarions. DO NOT EXCAVATE IN ANl'STREET AND <br /> DO�OT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a pernut does not gzant this approval. <br /> 7. All w�ork must be done in accordance with State Code requirements. <br /> `s. All���ork must be inspected before it is covered. Call(952)249-4600,24 hour notice required. <br /> J OB SITE :�DDRESS: �r� �- C � �!�-� � � <br /> �ccupanc��Type: �Residential Com ercial-- <br /> ��vner's Name: , � � � �-�-Y� U'� Phone Number:..-���"��� <br /> :�tailing Address: v�'Y -S �� L� City: �--����" Zip• <br /> �Contractor's Name: ;� �-� ��- Phone Number: ��2 Gks-���S«> <br /> i`Iailing Address:�r ��,� /S ' City: (��� 2.� Zip• ,5��?�/ <br /> Pi RI�IIT TYPE �"Connections ❑Repairs ❑Disconnect (Check One) <br /> S aC Charge (2003 rate $1,275.00) $ �/ C`'�--' (Set Rate) <br /> Sac Charge must accompany all sewer permit applications unless prepaid. <br /> f If not prepaid, a sewer connection will not be issued) <br /> � S � ��'' <br /> Nlunicipal Sewer Connection/Disconnect/Repair ($35.00 per stub) $ <br /> pipe size� inches; material l�L Schd 40 air tested; cast iron <br /> ,�Iunicipal Water Connection/Disconnect/Repair($35.00 per stub) $ � _S , �i c% <br /> pipe size�inches; material �--'S copper; other <br /> WATER METERS must be picked up and paid for at City Hall. <br /> �`>'ater meters must be set and sealed by Orono Water Department <br /> '"°i�2-249-4600) upon completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <br /> ERI�IIT FEE CALCULATION �c U� <br /> .. Subtotal of above permit requested $ <br /> �. State Surchar�e $ .50 (Minimum) <br /> The State Building Code Division Surcharge of 5.50 per permit must be <br /> included for each well,sewer and water connecrion permit requested. . <br /> 3. Postage & Handlin�(Only mail-in applications) $ (Mail In Only) <br /> �. TOTAL PERi'�IIT FEE (add lines 1-3 above) $ �� � �7U,�__. <br /> �,he undersi�ed hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict <br /> _ccordance�vith the ordinances of e City and the regulations of the State of Minnesota, and certifies that all statements <br /> �ade on this application^ compl , rue and correct. <br /> ;- ------__ _ <br /> _ .._.._--—.�___ <br /> �---� <br /> Signature of Appl'' –Date:-- ��^���2`�'�3 <br />