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CI'I'�Y OF ORONO APPLICATION FOR UTILITY PERMITS <br /> # Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <br /> l. 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 fee shown below. Permit cards will be sent by <br /> return mail the same day the application is received. <br /> 3. Permits are not valid untit 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 o�ly. <br /> 6. Contact the Public Works Department (952-249-4600) for utility stub as-built locations. DO NOT <br /> EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public <br /> Works 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(952)249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: ___l l �� �,4.G�.rNr SS P�1- �� <br /> Occupancy Type: �— Resident'al � Commercial <br /> Owner's Name: �,����l�,�s�-� ��}-��h�1 (�;J��hone Number: (�lZ-70 /- .�� ��� <br /> Mailing Address: City: O �c�� 7�• 5 Z <br /> Contractor's Name: �( �G����i s�� d�-vV+ti� �.t Phone Number:_��Z--��5--2�T y �( <br /> Mailing Address: �'U, ��� �S City: (.�.�,z-� 7�• ��f <br /> � <br /> �-��'�� PERMIT TYPE <br /> ,� ��. �XMunicipal Sewer Connection ($35.00 per stub) $ <br /> ^G-' ���" pipe size inches; material Schedule 40 air tested; cast iron <br /> � ���� SAC Charge (2000 rate $1,150.00) must accompany all sewer permit applications unless prepaid. <br /> (��� If not prepaid, a sewer connection permit will not be issued. <br /> \' <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 /> Water meters must be set and sealed by Orono Water Department (952-249-4600) upon <br /> completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks = 75' <br /> REQUIRED setback from sewer line=20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <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& Handling (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 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 Applic Date: ��� ��/ <br />