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, . <br /> (Updated 12/29/04) <br /> CITY OF 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 pernlits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Pernlit 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 permit card is available on the job site. <br /> �. Utility connection pennits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Departmeut(952-249-4600)for utility stub as-built locations. DO NOT E�CAVATE 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 <br /> approvai. <br /> 7. All work must be done in accordance with State Code requiremeuts. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600,24-48 hour notice required. <br /> JOB SITE ADDRESS: _ _ �G -�:� f.c/�— ��•��v,���� <br /> Occupancy Type: jC Residential Commercial <br /> Owner's Name: Jy���-��l ,�;�;s;,�,�..�,:: �. /,«-�3 phone Number: �/�- ���� - ��/' <br /> Mailing Address: ��< <i�_z��-- City: Zip• <br /> Contractor's Name: W�/�� <<�K��.��. �;,�_.-jG�Phone Number: ys�- y�-r -s��c;� <br /> Mailing Address: ia'y�s- u� �=�< is- Cityr>-�,��/f��/�:�-Zip• �-s=3>f' <br /> PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2005 rate $1,450.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer perniit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Connection/Disconnec�/Repair ($35.00 per stub) $ <br /> pipe size�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 Dcpartment(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 /> 1. 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 permit requested. <br /> 3. Posta�e & Handling (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 are complete, true and correct. <br /> ,� � <br /> Signature of Applicant: %�-3 ���_=--�-����-��-��- Date: � ��-.z>'� <br /> I <br />