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. ., _ <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 5�323 <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Nlailed in applications are subject to the posta;e and handlin;fees shown below. Permit cards will be sent <br /> by return maii the same day the application is received. <br /> ;. 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 /> 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 /> Deparhnent. 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: �� C� �� �� � �� <br /> Occupancy Type: Residential Commercial <br /> O�vner's Name: �-�t'� ��-�''"' Phone Number: <br /> Mailing Address: �� � ' � �� � City:�� ���- Zip: .�,35 G <br /> Contractor's Name• ,�c�.` Lc�'r-,�,, ��/�''-��-G Phone Nfimber:f/Z -�i�-�Li`�< <br /> Nlailing Address: 7f�-�� �,.���n- �f City: � 7ip: ��5�,�7,� <br /> PERNIIT TYPE <br /> �Iunicipal Sewer�onnection ($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 /> I�Iunicipal `Vater Connection ($3�.00 per stub) $ <br /> pipe size inches; material copper; other <br /> ��'ATER 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 se�ver line = 20' <br /> PERi1�IIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> ?. State Surcharge $ .50 <br /> The State Buildin�Code Division Surcharge of$.50 per permit must be <br /> included for 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 /> Nlinnesota, and certifies that all statements made on this application are complete,true and correct. <br /> � <br /> Sianature of Applicant: " �'`~- ��'�-� Date: ' � � � <br />