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a. (Updated 1/5/04) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER & SAC <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <br /> 1. Yo�i ivay apply for utility�ennits by mail or in person at the City oftices. <br /> 2. Mailed in applicltions are subject to the postage and handling fec shown below. Pennit cards will be sent by retum mail the same day <br /> ihc application is rcccived. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the penuit card is available on the job site. <br /> 5. Utilily connection permits may be issued to licensed conlractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility shib as-built locations. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MA lN without express approval of thc Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. All work must bc donc in accordance with State Codc rcquiren�cnts. <br /> 8. All work inust be inspected before it is covered. Call (952)249-4600,24 liour notice required. <br /> JOB SITE ADDRESS: S ��G��- <br /> Occupancy Type: �'`- Reside Y 1 Commercial <br /> Owner's Name: In d- �� LZ �- Phone Number: <br /> Mailing Address: � City: Zip: ,s � <br /> Contractor's Name: l Gr "1'� • Phone Number: — � .33� <br /> a �. <br /> MailingAddress: .S� 6l� City: �{ Zip: �Sy2� v <br /> � <br /> �� `� <br /> PERMIT TYPE ❑ Connections �Zepairs ❑Disconnect (Check One) .j � <br /> �� G� <br /> SAC Charge (2003 rate $1,350.00) $ (Set Rate) „��� � <br /> Sac Charge must acco�npany all sewer permit applications unless prepaid. ,�(�� �9'� <br /> (If not prepaid, a sewer connection will not be issued) �� �� <br /> �, � ' � � a � <br /> Municipal Sewer Connection/Disconnect Repair $35.00 per stub) $ �S � L� <br /> pipe size_� inches; inaterial P�r�Ci Schd 40 air tested; cast iron '�-� _ � � <br /> — J �` <br /> Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $ � <br /> pipe size inches; �naterial copper; other ��a <br /> (� � �,� <br /> WATER METERS must be piciced up and paid for at City Hall. �� <br /> Water meters must be set and sealed by Orono Water Department <br /> � <br /> (952-249-4600) upon completion of ineter installation. �-' <br /> REQUIRED minimtiim setbacks froin drain field and septic tanks = 7S �,� <br /> REQUIRED setback from sewer line= 20' <br /> G�`�-��( <br /> PERMIT FEE CALCULA7'ION � �� � <br /> ]. Subtotal of above per�nit requested $ � �• � � <br /> 2. State Surchar�e $ .50 (Miniinum) �� <br /> The State E3uilding Code Division Surcharge of$.50 per permit must be <br /> included ior each well,sewer and watcr connection pennit requested. <br /> 3. Posta�e & I�andlin�(Only mail-in applications) $ � (Mail In Only) <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ �S_ �� <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Pennit, agrees to do ali wark in strict <br /> accordance with the ordii�ances of the City and the regulations of the State of Minnesota, and certifies that all statements <br /> made on this application are complete, true and correct. <br /> Signature of Applicant: Date: <br /> Reset Form <br />