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(Updated 1/5/04) <br /> CIT�' OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 6t��2750 Kelley Parkway) SEWEWWATER & SAC <br /> C�-ystal Bay, MN 55323 <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pern�its by inail 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 return �naiL the satne day <br /> the application is receivcd. <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 thc job site. <br /> 5. Utility connection pennits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. All work inust 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: �� � � ��d�e R�` <br /> Occupancy Type: Residential X Commercial <br /> Owner's Name: '�Q�,t��QXI Cd �-�Ct��a� Phone Number: 5 '�j 2.-• 'i?3 ' 3 �Oq� <br /> Mailing Address: "�4 5Go �jp.5,s�uf Lv� ('�eOr�- - City:l�2,(J�d Zip: s S 3 7 3 <br /> Contractor's Name: �3Phone Number: <br /> Mailing Address: � "` • City: Zip: <br /> y , <br /> Rameay, A�p�..�5 303 <br /> PERMIT TYPE [�Connections LJ Repairs ❑ Disconnect (Check One) <br /> SAC Charge (2003 rate $1,350.00) $ (Set Rate) <br /> Sac Charge must accompauy all sewer per�nit applications unless prepaid. <br /> (lf not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Connection/Disconnect/Repair ($35.00 per stub) $ <br /> pipe size inches; material Schd 40 air tested; cast iron <br /> do <br /> Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $ ,3 S <br /> pipe size� inches; material��copper; other <br /> WATER METERS �nust 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 minimuro setbacks froin drain field and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <br /> PERMIT FEE CALCULATION a,,� <br /> I. Subtotal of above pennit requested $ ?'s <br /> 2. State Surchar�e $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per per�nit inust be <br /> included for each well,sewer and water connection pennit requested. <br /> 3. Posta�e & Handliug (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 work in strict <br /> accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements <br /> made on this application ar omplete, true and correct. <br /> Signature of Applicant: Date: �v �u d <br /> Reset Form <br />