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�U�11'�7tCf�Z�IZ�O1� <br /> �;.ITY•OF ORONO APPLICATION FOR UTILITY PERIVIITS <br /> Bos 66 (2750 Kelley Parkway) SEWER/WATER � �� <br /> Crystal Bay, MN 55323 O '?-, <br /> J <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 <br /> return mail the same day the application is received. <br /> ;. Permits are not valid until you receive a permit card. <br /> d. 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 <br /> EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public <br /> 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: � � �� v�i �� � � � �' <br /> Occupancy� Type: � Resi ential Commercial <br /> O�`ner's Name: C_' Phone Number: <br /> l�Iailing Address: City; rn G�.;v`, 7ip: <br /> Contractor's Name:�' �' �(�a. �; S4-� Phone Number: G S:1-��(7�� �3 � V <br /> 1�Tailing Address:S;', �� ��, p�e ���r City: � ,� Zip: �3 L � <br /> PERMIT TYPE �� <br /> ��unicipal Sewer Connection ($35.00 per stu $ �� <br /> pipe size�inches; material � ��chedule 40 air tested; cast iron <br /> S:�C Charge (2000 rate $1,150.00) must accompany all sewer permit applications unless prepaid. <br /> If not prepaid, a sewer connection permit will not be issued. <br /> n�unicipal Water Connection ($35.00 per stub) $ <br /> pipe size inches; material copper; other <br /> ��'ATER METERS must be picked up and paid for at City Hall. <br /> «'ater meters must be set and sealed by Orono Water Department (9�2-249-4600) upon <br /> 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 <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. Posta�e & 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 work in strict accordance with the ordinances of the City and the regulations of the State of <br /> I�linnesota, and certifies tha all statements made on this application are complete,true and correct. <br /> � - �� �� ) <br /> Sianature of Applic t: � Date: � � <br />