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CITY OF ORONO APPLICATION FOR UTII�ITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> - ` Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pernuts 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 /> rehun 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 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 e�cpress 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 before it is covered. Ca11249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: I C� � C� G Y�G �1,1, UG'1� I� 1 L.L.S n-U���' <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: l/ 1'� ' S � i�- ,f'�` I i`i Phone Number: <br /> Mailing Address: S G6'�L'vC�C�� LS �L � City: G+-� �� 7ap: <br /> Contractor's Name: � � �G��,��h,�L�1��� � Phone Number: � , ` S Z C <br /> Mailing Address:�-?/�lG �fv l L L C,:v' �r`�, �ii� City: �y ��� � ,� 7�p: <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stu $ �S: �� <br /> pipe size 4 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= 7S . <br /> REQUIRED setback from sewer line=20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ � 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 pernut requested. <br /> 3. Postage & Handlin� (Only mail-in applications) $ �6 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ 3 S- �� <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 /> Signature of Applicant: i �/ ������'_ Date: ���� <br /> �% <br />