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(Updated 6/2/03) <br /> CITY�F 04ZON0 APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SE`VER/WATER& SAC <br /> �rystal Bay, MN 55323 <br /> �.iENERAL INFORMATION <br /> �. You may apply for urility pernuts by mail or in person at the City offices. <br /> '. Mailed in applications are subject to the postage and handlinJ fee show�n below. Permit cards wili be sent by return mail the same day <br /> the application is received. <br /> �. Permits are not valid until you receive a permit card. <br /> !. Work must not begin unless the pernut 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 uti?ity stub as-built locations. DO NOT EXCA`'ATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public�%orks Department. Issuance of a permit does not gzant this approval. <br />' 7. All work must be done in accordance with State Code requirements. <br />' �. All work must be inspected before it is covered. Call(952)?-�9-4600, 24 hour notice required. <br />', JOB SITE ADDRESS: '�1 ���J I+r �i�ov� �'� ` <br />' Occupancy Type: � Residential Commercial <br />'� Owner's Name: Phone Number: <br /> Mailing Address: City: Zip: <br /> I Contractor's Name: '�e<-�, l,/� � ' ..� Phone Number: ��S.?1 Y�..?- y9 � `% � <br /> Mailing Address: ��S o� l� . ��� i�� Cit��:��h.,��-7r.1 Zip:� S"����� <br /> PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One) <br /> �C Charge (2003 rate $1,275.00) $ (Set Rate) <br /> ..� Charge must accompany all sewer permit applications unless prepaid. <br /> �Lf not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer �onnection/Disconnect/ pair ($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) $ <br /> pipe size inches; material copper; other <br /> �;'ATER METERS must be picked up and paid for at Cin�Hall. <br /> �Vater 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 /> PERNIIT 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 pernut must be <br /> included for each well,sewer and water connection pernvt requested. , <br /> 3. Postage &Handlin�(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 ardinances of the City and t t�egulations of the State of Minnesota, and certifies that all statements <br /> made on this application are complete, true co ect. <br /> C � Cni <br /> Signature of Applicant: ��� Date: � � � <br />