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_.. .� . _ . <br /> CITY OF ORONO APPLICATION FOR IITILITY PERMITS <br /> � Box 66 (1335 So Brown Rd) SEWER WATER <br /> Crystal Bay, MN 55323 � <br /> *********************************�********************�******************** <br /> I; You may�pp�or utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fees shown below. <br /> Perniit cards will be sent by return mail the same day the application is received. <br /> 3. Pe.imits are mt valid iurti.l y�ou reoeive a peYmit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Dep�stment (473-7357) for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY SIREET AND DO NOT TAP ANY MAIN without express approval of the <br /> Public Works 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. Cal 1 473-7357. <br /> 24 ho�ir natioe required. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: �-� �' � ��,/� ' � r �� <br /> Occupancy Type: � Re i ential Commercial <br /> OWNER'S NAME: % � = ; /�,� Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAME:�-�j r �-- ��� �"�i�;�,�� ,;_ =�" Bus . Phone: � � - ` � �/ <br /> Mailing Address: ��,c � - � , ,,., ., � , ` � �% � Zi f��?�l. <br /> � � � � City:`„ J, p: <br /> ***************************** ************************�******************* <br /> ___ __ <br /> �; .�;'r_PERMI T TYPE AND F$S CALCUI�ATI ON <br /> MIINICIPAL SEWFR CONNECTION ( $�$0 per stub) $ %•- � <br /> pipe size ��..��inches; material �% PVC (on sand fill ) ; cast iron <br /> SAC Charge f$700.00 ) must accompany al l sewer permit applications unless <br /> prepaid. If not prepaid, a sewer connection permit will not be issued. <br /> _-;_� c�'Z-- <br /> MIINICIPAL WATER CONNECTION ( $-�II�O 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 /> Water meters must be set and sealed by Orono Water Department (473-7357) <br /> upon co�nnpletion of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75 ' <br /> REQUIRED setback from sewer line = 20 ' <br /> *************************************************************************** <br /> 1. Subtotal of above permit requested $ f �; � /' <br /> 2. State Surcharge . 50 <br /> The State Building Code Division Surcharge of .50 per permit must be <br /> included for each well, sewer and water connection permit requested. <br /> 3 . Postage � Handling (Only mail-in applications) $ 1. 50 <br /> 4. TOTAL PERMIT FEE (add Iines 1-3 above) $ <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, <br /> agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this <br /> application are co�lete, true an�correct. ; _ <br /> / yi � <br /> Signature of Applicant:%� ���-�, �<%���� 'L - _ - Date: � ^ / / - /-� <br /> �� <br />