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CITY OF ORONO APPLICATION FOR UTILITY PER1dIITS <br /> , Box 66 (2750 Kelley Parkway) SEWER/WATER , <br /> � Crystal Bay, MN 55323 ,,��� <br /> � �1 <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. Permit 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 permit card is available on the job site. <br /> S. 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 /> 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 /> �'- .--_ <br /> JOB SITE ADDRESS: ����-''J �� t- ���t�I�X����-� �E= ��CI • <br /> Occupancy Type: Residential _�Commercial <br /> Owner's Name: ` � �[�I l.� �w' �S `.{ ' Phone Number: � -*`� l �;__(;;`> <br /> Mailing Address: � �� l ,�CC_, �C'ity: � ��i�r�r'� �;�� 7ap: <br /> Contractor's Name: `� '�.� -i'�'� � ' �)� t )C Phone Number: �}..-' �-���1C`� ; <br /> , <br /> Mailing Address: �-.?.' >> City: ' ��' ti( 7ip: �.J` <br /> PERMIT TYPE �, �,�� <br /> Municipal Sewer Connection ($35.00 per stub) $ � �-� <br /> pipe size �� �` inches; material`��X J�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 /> � ;,��;- � ,`r ��� <br /> .�. , � <br /> � ��-� <br /> ��� ��� �-��� r <br /> Municipal Water Connection ($35.00 per stub).t1 �� ;�,�. � ,;.t � $ ��--� <br /> pipe size�'` inches; material ��.����.�- 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 /> REQi1IRED minimum setbacks from drainfield and septic tanks= 75' <br /> REQUIRED setback from sewer line= 20' <br /> PERMIT FEE CALCULATION ;Y, <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) $ ` 7���' � `x�', <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 /> � �l <br /> r ,, <br /> - , ,� ( <br /> ��y I I/ ' � � <br /> Signature of Applicant: ` �� �I �� II��"�-�-'r� Date: � �� '� <br /> `�J <br />