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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> - Box 66 (2750 Kelley Parkway) SEWER/WATER <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. Pernut 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 pemut 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 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 /> 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 bePore it is covered. Ca11249-4600. <br /> 24 hour notice required. <br /> B ITE ADDRESS: � '. �. �i �.k. �,�� k-�L i�.-� � ��� f � , �,� '� . ��G <br /> � JO S LL. <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: � . 4 � �1�-� Phone Number: <br /> Mailing Address: 1��� ��C���'l.C��>� 1 c.'' City: � � 7ap;�'�'r Gz <br /> Contractor's Name: . ( Gt�, l 1 Phone Number: '� � � s <br /> Mailing Address: � ► City: � � � 7ap:,, <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub $ 3 S� �� <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) $ 4���1[,► <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_ � d <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. Posta�e & Handlin� (Only mail-in applications) $ —}� <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ 5 � _.SIJ� <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 /> _ � j � <br /> Signature of Applicant: -� "���� _ Date: �r��--�`,"�' <br />