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CITY OF ORONO APPLICATION FOR UTILITY PEP-1'+�IITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER �� � Q�� <br /> ' Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <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 fees shown below. Permit cards will be sent by <br /> return mail the 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 pennit card is available on the job site. <br /> 5. Utility connection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Departrnent (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 /> 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. Ca11473-7357. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: � 3�i �� �� ������� /��v C, <br /> Occupancy Type: `� Residential Commercial <br /> Owner's Name: `��3�,,, j� %�c��-, Phone Number: �/7�- `��/ �7� <br /> Mailing Address: �i 3�>/.���;�:. f�, �,,- c City: �'� a-�.�,,_�- tip: S S 3 SC <br /> Contractor's Name: �t,//;��,,,�;C4ti-1,��� ����:� -5 Phone Number: =/ �3 - ��;�>G <br /> , <br /> Nlailing Address: ;�C c� i��'w��� i��/So, City: �.C��,��>,_ �,-� 7�p: ;���3��/ <br /> PERMIT TYPE <br /> Nlunicipal Sewer Connection ($35.00 per stub) $ <br /> pipe size�_inches; material ' Schedule 40 air tested; cast iron <br /> SAC Charge ($1,050.00) must accompany all sewer permit applications unless prepaid. If not <br /> prepaid, a sewer connection permit will not be issued. <br /> �Iunicipal Water Connection ($35.00 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 = $130.00; 3/4" meters= $180.00; 1" meters= $240.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department(473-7357) upon completion <br /> of ineter installation. <br /> REQUIItED minimum setbacks from drainfield and septic tanks= 75' <br /> REQUIRED setback from sewer line= 20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 <br /> The State Building Code Division Surcharge of$.50 per pernut 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 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 conect. <br /> ���'�, / �� �� _, <br /> Signature of Applicant: ��;'�%�'i�z� �;��������-' Date: �—��� ��' <br />