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r - CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWERJWATER <br /> Crystal Bay, MN 55323 <br /> GENERAL 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 fees shown below. Pernut cards will be sent by <br /> 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 begin unless the pernut 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 Departrnent(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 pernut 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�I 1.� l`� � �`��'�� �- � "�' <br /> Occupancy Type: �' Residential Commercial <br /> Owner's Name: �-.�9���� C �- Phone Number: �t�� � � V L� <br /> Mailing Address: ��n.�-c City: 7�p: <br /> Contractor's Name:�c� ��S N � �*--� � Phone Number• � �7��-`3 � ao <br /> Mailing Address: SJ �'c.� qy� a�� \,�� City: �1 ��t,.�i 7ap:_E��y <br /> J <br /> PERMIT T'YPE ��� <br /> Municipal Sewer Connection ($35.00 per stub $ �� <br /> pipe size�inches; material � ��Schedule 40 air tested; cast iron <br /> SAC Charge ($1,0�0.00) must accompany all sewer pernut applications unless prepaid. If not <br /> 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 /> (5/8" meters= $130.00; 3/4" meters= $180.00; 1" meters= $240.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water 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 /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ � � , � �' <br /> 2. State Surchar�e $ .50 <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 <br /> 4. TOTAL PERNIIT 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 work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies th all statements made on this application are complete, true and correct. <br /> Signature of Applic � Date: �r � � _ <br /> � <br />