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._ �-�ITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 �` <br /> , <br /> GENERAL INFORMATION �`� <br /> l. You may apply for utility pernuts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fees shown below. Pemut cards will be sent <br /> by retum mail the same day the application is :eceived. <br /> 3. Permits are not valid until you receive a per�►it 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 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. Call 473-7357. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: � y 6� c f�f'"'"�� <br /> Occupancy Type: �' Residential Commercial <br /> � <br /> Owner's Na.-ne: (;�G�.�`�J 1/!tl�:"r:✓�' PhoneNwnber: y��— �s �-!�j' <br /> Mailing Address: ,� y 6 s J= L���.?s City: � ���G 7�: ��{, ,_ � <br /> Contractor's Name: ���c t,�,�'��'�'.�u� �/ PhoneNumber: �*.;' .,-' �'�C;�' <br /> . ,. ,� City . <br /> Mailing Address: � � � r/,��� �yf� ' _ . . 7�p <br /> _�t. . ._ _ � ,,,; ;���,,1 r w� .� <br /> PERMIT TYPE �. �� <br /> Municipal Sewer Connection ($35.00 per stub) $ 1' _ <br /> pipe size 1� inches; material `��- PVC (on sand fill); cast iron <br /> SAC Charge ($750.00) must accompany all sewer permit applications unless prepaid. If not <br /> prepaid, a sewer connection pernut will not be issued. <br /> Municipal Water Connection ($35.00 per stub) $ <br /> pipe size inches; material copper; ot�er <br /> WATER 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 (473-735'n upon <br /> completion of ineter installation. <br /> REQUIRED minimum setbacks from drainf'ield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <br /> PERMIT FEE CALCULATION <br /> l. Subtotal of above permit requested � <br /> ,.� "� . �- <br /> 2. State SurcharQe $ .50 <br /> The State Building Code Division Surcharge of$.50 per permit must be t e .;' :� `�-' <br /> included for each well, sewer and water connection 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 /> �J �,; <br /> Signature of Applicant: �!_ `� -='` '� �� '� r�� � ~�3 <br /> �`"�,'`,� <br />