Laserfiche WebLink
CITY OF ORONO APPLICATION FOR UTIi.ITY PERMITS <br /> . <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 sho�vn below. Pernut cards will be sent by <br /> return mail the same day the application is received. <br /> 3. Permits are not valid untii 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 (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 ' � �'f�����' � �-� ��V� <br /> Occupancy Type: Residential Commercial <br /> Owner's Name:�f��1� �,j1„;�F� S � r�"i(�?�S�/��1 Phone Number: <br /> Mailing Address: �,(,�� > l, �n'� I;�L�[.C�� �l l-LS (LI� City: �' 7ap• C <br /> Contractor's Name: _ �1, r � Phone Number: - � <br /> � Mailing Address: ) > (, / ,�L ✓�'�. City:�%V^ J I 7�p: SS � � <br /> PERMIT TYPE <br /> Municipal Sewer onnection ($35.00 per stub) $ �S-�d <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 $ 2.�S-� �� <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) $ 1��- <br /> 4. TOTAL PERNIIT 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 /> . 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: ����� <br /> �� � <br /> Il� <br />