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�l.;pdated 2/12/O1) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Bo� 66'�2�150 Kelley Parkway) SEWER/WATER � b <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 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 permit card is available on the job site. <br /> �. Utility connection permits 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 ofthe Public Works 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. Call(952)249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: I � � P�'. <br /> Occupancy Type: Residential Commercial <br /> Owner's Name:_�o�✓��� � i�h�rc<<� J�N��� Phone Number:_y,�� -y 7,3 -Q 7,Z� <br /> Mailing Address: �1�'O i-1�,R � ��1 c�� ,t���' City: G(:��v�� Zip• ,5-1'3 ��'� <br /> Contractor's Name: }{lv H U��w �'�!� Phone Number: �5�-4.3 3�;�6 vc=; <br /> Mailing Address: �-c 3c� l�-1 u�� U�r�u ('�.J��� City: rn�-«>� Zip: ,��3`�J <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ <br /> pipe size�_inches; material 7J�Schedule 40 air tested; cast iron <br /> SAC Charge (2002 rate $1,200.00)must accompany all sewer permit applications unless prepaid. If not prepaid, a sewer <br /> 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 /> Water meters must be set and sealed by Orono Water Department (952-249-4600) upon completion of ineter <br /> 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 <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 & Handling (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 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 of Applican � ` � ���-�.-•�� Date: � ��/ —U� <br />