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CITY Or ORONO .' � APYLICATION rOR UTILITY PEItMITS <br /> Box G6 (2750 Kelley Parkway) � }� SEWER/WA�r�u <br /> Crystal Bay, MN 55323 -�� � <br /> � <br /> GLNI;RAL INrORMATION <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 dic postage and handling fees shown below. Permit cards will Ue sent <br /> by return mail the same day the application is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work �nust not bcgin unless the permi[ card is available on the job sitc. <br /> 5. Utility conncction 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 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 /> S. All work must be inspected before it is covered. Call 473-7357. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: � <br /> Occupancy Type: - Resi ential ,. , Commercial <br /> Owner's Name: PhoneNumber: <br /> Mailing Address: h — ' , City: 7�p: <br /> Contractor's Naine: _; PhoneNumber:�< - / �' � <br /> Mailing Address: � � City:� - ' �p:. �'��'i� — <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per slub) � <br /> pipe size � inches; materia�'. yG� PVC (on sand fill); cast iron <br /> SAC Charge ($850.00) must accompany all sewer permit applications unless prepaid. If not <br /> prepaid, a sewer connection permit will not be issued. <br /> Municipal Water Connection ($35.00 per stub) $ <br /> pipe size inches; material copper; otlier <br /> WA'1 ER 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 /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department (473-7357) upon <br /> completion of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> REQUIR�D setback from sewer line = 20' <br /> PCRMIT FEE CALCULATION <br /> 1. Subtotal of above I�ermit requested � <br /> 2. State Surchar�e $ .SU <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each well, sewer and water connec[ion permit requested. <br /> 3. Posta�e & 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 <br /> do all work in strict accordance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Signature of Applicant: �> I �.�����1�. Date: �' /� �,5 <br />