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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> `r �- Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pemuts 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 by <br /> retum 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 pernut 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 (249-4600)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 /> Departrnent. Issuance of a pernut 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. Ca11249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: � ' S �b 6' �.� �� �l �.S " '� <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: L- Phone Number: <br /> Mailing Address: ✓.1• �OU �"City:G' � ` ;�� � ` 7ap:�� <br /> Contractor's Name: L C L�P�i ' Phone Number: ��' q �'w] <br /> Mailing Address: �- (�(� ��,il�L��tJ r� City:j�;^�Y,��� �,,�� 7�p: ,S <br /> PERMIT T'YPE <br /> Municipal Sewer Connection ($35.00 per stub) $ 3 >>�� <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 /> Municipal 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(249-4600) upon completion <br /> of ineter installation. <br /> REQUIRED 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 $ � S. C�� _ <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) $ --�-58 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ , � - � l� <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 correct. <br /> � <br /> �� �� ���. <br /> Signature of Applicant: Date: � = � 7 � <br /> J � <br />