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(iJpdated 5/3/02) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC r � S( <br /> Crystal�Bay, MN 55323 �� ��-f' J <br /> : <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pemuts 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 connection pernuts 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�ant this approval. <br /> 7. All work must be done in accordance with State Code requuements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600,24 hour notice required. <br /> JOB SITE ADDRESS: �?' �/-�/��/� �d�L <br /> Occupancy Type: Residential �Commercial <br /> Owner's Name:�/,J,�v �,�ls-/✓�-s�T,9.e,��' ���� Phone Number: <br /> Mailing Address: City: Zip: <br /> Contractor's Name: w�,�� ��� Phone Number: �.�-a-s�y�iYt�,� <br /> Mailing Address: �v�>� dfF- �.,�.�f��•��> City: Zip: S.3-�3��" <br /> PERMIT TYPE .D�onnections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2002 rate $1,200.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Connection/Disconnect/Repa' ($35.00 per stub) $ /��� <br /> pipe size��� inches; material Schd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $ �a� � <br /> pipe size G `t inches; material�opper;��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 /> l. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 (Minimum) <br /> The State Building Code Division Surcharge of$.50 per pernut must be <br /> included for each well,sewer and water connection pernvt requested. <br /> 3. Postage & 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 /> Signature ofApplicant c� "��-r���,�c� Date: � -��� <br />