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CI�Y OF ORONO APPLICATION FOR UTILITY PERMITS <br /> ` Bos 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 <br /> GEPIERAL 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 posta�e and handling fees shown below. Permit cards will be sent <br /> by 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 bejin unless the permit 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 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 /> i � / <br /> JOB SITE ADDRESS: �7�� C� ` �- C/y��� �� <br /> Occupancy Typ • Residentia Commercial � <br /> � � i /� � <br /> Owner's Name: �;� ��-� / .-����-'�i�-' Phone Number: � �%-� - -��� j <br /> �lailing Address: /J �-�=�� � City:��� ��`'-�"��� 7�p: � ��,�5�� <br /> Contractor's Name: � ��'-�=r C<�''`�-'' Phone Number: 7,%" �- %� � /' <br /> Nlailing Address: �� , �� �z �:.-•-�,-<�/'--� City: %�==' z�! Zip: }_y_���� <br /> � <br /> PERi�IIT TYPE <br /> ��Tunicipal Sewer Connection ($35.00 per stub) $ <br /> pipe size inches; material Schedule 40 air tested; cast iron <br /> SAC Charge (2000 rate $1,100.00) must accompany all sewer permit applications unless prepaid. <br /> If not 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 /> `Vater 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= 75' <br /> REQUIRED setback from sewer line=20' <br /> PERIVIIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 <br /> The State Buildin�Code Division Surchar�e of$.50 per permit must be <br /> included foc each well, sewer and water connection permit requested. <br /> 3. PostaQe & Handlin� (Only mail-in applications) $ 1.50 <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 <br /> all �vork in strict accordance with the ordinances of the City and the regulations of the State of <br /> �linnesota, and certifies that all statements made on this application are complete,true and correct. <br /> � <br /> �-,��- ,��--,- Date: � __ �7 - � iJ <br /> Signature of Applicant: �"='� <br />