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(Updated 6/2/03) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 6�5 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crysfal Bay, MN 55323 <br /> GENERAI.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 fee shown below. Permit 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 pernut card is available on the job site. <br /> 5. Utility connecrion pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locarions. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public Works Deparhnent. Issuance of a pernut does not gzant 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. Call(952)249-4600,24 hour notice required. <br /> JOB SITE ADDRESS: _ �� (v D �/`3� cY P.� �� <br /> Occupancy Type• Residential Commercial <br /> Owner's Name: � � �. �� �� 'T'� Phone Number: <br /> Mailing Address: City: Zip: <br /> Contractor's Name: /1'l�0 ���,•►r�./�:SPr�/��,,,� Phone Number: ,�,�' �-�-�.-j�,�•� <br /> Mailing Address: S'�9b Qu.t��r-t ��.--L City: t , � Zip: .�"s�'7� <br /> PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,275.00) $ (Set Rate) �a�.3U� <br /> Sac Charge must accompany all sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> G� <br /> Municipal Sewer onnection/Disconnect/Re� ' 00 per s ., $ ��� <br /> pipe size « inches; material , Schd 40 r test ; c st iron <br /> Municipal Water Connection/Disconnect/Repair ($35.00 per $ <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 Department <br /> (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. Postage & Handlin�(Only mail-in applications) $ 1.50 (Mail In Only) <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ ,3.�" � <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work �r� �trict <br /> accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all �tatear�ents <br /> made on this application are com ete, true and corre ,. � <br /> fi � �r <br /> Signature of Applicant: � .�"!,-.�� '�-a;�`r`'-�`�Y� Date: � ;�� <br />