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(Updated 6/2/03) <br /> CITY � ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pernrits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will be sent by return mail the same day <br /> 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 Department(952-249-4600)for utility stub as-built locarions. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a pemut does not gzant 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)249-4600,24 hour notice required. <br /> JOB SITE ADDRESS: �`l.� 1'y l�RTI-j I=� C��N D/1 L L= ,/Z�rA l� <br /> Occupancy Type: ✓ Residential Cornmercial <br /> Owner's Name: 7A� I ��}N �TU i�'e �'Si S Phone Number: <br /> Mailing Address: 3�,� NG �27ia rL-'RN vq�� ��c,j ry City: L:,��rv r_; Zip: `�j 3�7� <br /> Contractor's Name: ��112 RU�7 TL� Phone Number: 7�;- �, 7 l— c� -; 5 5 <br /> Mailing Address:��cJ 0 C/�N1 i��4> >R. z#'4 c� CitY: i��v��C� -�r Zip: '�S q� I <br /> PERMIT TYPE ❑Connections LJ Kepairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,275.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Connection/Disconnec epair $35.00 per stub) $ <br /> pipe size E: inches; material �'v :� Schd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect/Repair ($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 <br /> (952-249-4600) upon 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 /> l. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each well,sewer and water connection pemut requested. <br /> 3. Posta�Te &Handlin� (Only mail-in applications) $ 1.50 (Mail In Only) <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 all vv�rk �.�a �trict <br /> accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that �Y� st�.���ents <br /> made on this application are complete, true and correct. <br /> Signature of Applicant: �.��� ����,5j�n��,X Date: ���� �f�C>,7 <br />