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(Updated 6/2/03) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORI�IATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Maile�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 applicarion is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connecrion permits 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 ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a permit does not gtant this approval. <br /> 7. All work must be done in accordance with State Code requu-ements. <br /> 8. All work must be inspected before it is covered. Call(9�2)2-�9-4600,24 hour notice required. <br /> JOB SITE ADDRESS: � / I � ����U' ` �, L � <br /> Occupancy Typ� Resident t - Commercial <br /> Owner's Name: 1 ;� �� ^��lv�-�c-� �- Phone Number:��il ��� / ;� ��/ <br /> Nlailing Address: --�-------- City: Zip: <br /> Contractor's Name: � /V �`/'f i3/5 0 )')'�,�,` ��h7 Phone Number: ��S Z- �1�� ��/7�� <br /> Mailing Address: ���: ��� ,�� � City:����{z.���-� ZiP' S'����,L <br /> PERMIT TYPE ❑Connections ' <br /> ❑Repairs isconnect (Check One) <br /> SAC Charge (2003 rate $1,275.00) $ (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 /> � ��. <br /> , <br /> Municipal Sewer Connection/Disconnect/Repair (535.00 per stub) $ � -� i c-' <br /> pipe size inches; material Schd�0 air tested; cast iron <br /> Municipal Water Connection/Disconnect/Repair (S35.00 per stub) $ <br /> � �� �=% c_� <br /> pipe size inches; material copper; other <br /> WATER METERS must be picked up and paid for at Cit�-Hall. <br /> Water meters must be set and sealed by Orono«"ater Department <br /> (952-249-4600) upon completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks = 75' <br /> REQUIRED setback from sewer line=20' <br /> PERi1�IIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ �i C-� -' <br /> 2. State Surcharae $ �.50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each well,sewer and water connection pemut re�uested. � <br /> 3. Posta�e & Handling (Only mail-in applications) $ 1.50 (Mail In Only) <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $�-7�; ��-= <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict <br /> accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements <br /> made on this application are cor�e-' rue and correct. <br /> __ . <br /> --_ __.._. _. _�--�_----�._-______..__ `�_/Z ��� <br /> Signature ofApplicant; --- �"'� _ --------- - --- ' Date: <br /> ��`--- <br />