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��l� CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> ' Box 66 (2750 Kelley Parkway) SEWER/WATER ��' <br /> Crystal Bay, MN 55323 � �� <br /> GENERAL INFORMATION <br /> i. 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 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 Department(473-7357)for utility stub as-built locations. DO NOT EXCAVAT`E <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: '����'� l��-r� �_��-c� cJ�S <br /> Occupancy Type: %`�! Residential Commercial <br /> Owner's Name• <v r, 1 t��;ti.% Phone Number: <br /> Mailing Address: City: 7ip: <br /> Contractor's Name: )3z:s�,Sb �r,1�::,>. ,. � Phone Number: �� � ( s� ) �33• ���� <br /> Mailing Address: 3Ns�l �%���� � /�:� IL City: �:y��;�_ Zip; SL�i;�-� <br /> 'VIIT TYPE , <br /> _—._ <br /> ,.------ _ _ . <br /> `�____,Municipal Sewer Conng��$35.00 per stub) $ <br /> _ <br /> pipe size inches; material Schedule 40 air tested; cast iron <br /> SAC Charge($950.00)must accompany all sewer permit applications unless prepaid. If not prepaid, <br /> a sewer connection permit will not be issued. <br /> �� <br /> _-- - ----------_ <br /> __--_ <br /> ��__Municipal Water ConnQ��i�$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 = $139.00; 3/4" meters= $191.00; 1" meters= $247.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department(473-735'n upon completion _ <br /> of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' � <br /> F <br /> REQUIRED setback from sewer line =20' <br /> PERMIT FEE CALCULATION <br /> l. 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 permit 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 /> F <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 � ments made on this application are complete, true and correct. <br /> � % � <br /> ,�!i���� -�- <br /> Signature of Applicant:� � Date: �� �� , <br />