Laserfiche WebLink
f ,� (L1*::i lted 2/12/O1) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERIVIITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORMATION j��v � ' <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 posta�e 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 /> 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 <br /> EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public <br /> Works Department. 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 /> � � <br /> JOB SITE ADDRESS: �/� � ��o <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: �o�� ���G(��Sc� Phone Number:_� g/� -S SJ 7 <br /> Mailing Address: �//�� /��, �,,,,,��,�( i��� City: brvr,� Zip: SS 3� `/ <br /> Contractor's Name: Re� - R o�f Phone Number: 7U 3- .5�� - 3yd� <br /> Mailing Address: �L/5",�,p �7�—`'' �t/� J�J, City: y�/ ,�,,c�� 7�p:� <br /> PERMIT TYPE ��� ��� <br /> Nlunicipal Sewer Connection ($35.00 per stub) ', $ �3 C�� �" <br /> pi pe size `� inches; material Schedule 40 a r tested; cast iron <br /> SAC Charge (2000 rate $1,150.00) must accompany rmit applications unless prepaid. <br /> If not 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 /> Water 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 = 7�' <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. Postaae & 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 Ciry and the regulations of the State of <br /> Minnesota, and certifies that all st ents made on this application are complete,true and correct. <br /> � � <br /> Signature of Applicant: �'�( "" "l Date: — � ` � <br />