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CITY OF ORONO APPLICATI0�1 FOR UTILITY PERMITS <br /> ,, ,_ . 13ox G6 (2750 Kelley Parkway) S�`V�R/WATER <br /> Crystal I3�y, MN 55323 <br /> G(:NI;RAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at tl�e City offices. <br /> 2. Mailed in applications are subject to the postage and handling fees shown below. Permit cards�vill be sent by <br /> return mail ttie same day the application 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 connection permits may be issued to licensed contractors only. <br /> 6. Contact tlie Public Works Department(473-7357)for utility stub as-built locations. DO NOT EXCAVATE <br /> IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works <br /> Depnctment. [ssuance 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 473-7357. <br /> 24 hour notice required. <br /> JOBSITEADDRESS: C'' �C.� <br /> Occupancy Type: C/" sidential Commerci�l � <br /> Owner's Name: �j�� f,�2titi-�G-�-u Phone Number:_�'c'Y— l'�c7 3� <br /> Mailing Address: �s � � Cityy.,7�'� 7�p: �S.'.S'' <br /> Contractor's Name: f .�Z.ry,-�r�e Number: �;��'—�',j�9. <br /> Mailing Address: _�'� . 3�, '1!- � S_�' City:�'Z2ayy�-v� 7�p: ��3� `�� <br /> P�RMIT TYPC <br /> Municipal Scwer Connectioii ($35.00 per stub) $ <br /> pipe size inches; material��3 PVC (on sand fill); cast iron <br /> SAC Charge($850.0 )must accompany all sewer pennit applications wlless prepaid. If not prepaid, <br /> a se�ver connection permit will not be issued. <br /> Municip�l Water Connection ($35.00 per stub) $ <br /> pipe size inches; material copper; other <br /> WATER MF;TERS must be picked up and paid for at City Hall. <br /> (5/8" meters = $139.00; 3/4" meters = $191.00; 1" meters = $247.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Watcr metcrs must bc set and sealed by Orono Water Dep�rtment(473-7357)upon complction <br /> of mctcr installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks= 75' <br /> REQUIRCD setback from sewer line = 20' <br /> PF,RMIT F�� CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e - $ .50 <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each well,sewer and water connection pernlit requested. <br /> 3. Postage & Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add�lines 1-3 above) $ <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, 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 /> Signatuce of Applicant: � ,,C? � Date: /f,��- ��' <br />