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(LJpdated 6/2/03) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay, MN 55323 <br /> GENERAL IiVFORMATION <br /> 1. ��'ou 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 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 Department(952-249-4600)for utility stub as-built locarions. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public Works 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. Call(952)249-4600,24 hour ryotice required. <br /> , <br /> JOB SITE ADDRESS: I /�� �-c,Cr0 Cy � <br /> Occupancy Type: Residentia Commercial <br /> Owner's Name: 'r✓���" ��- � � Phone Number: <br /> Mailing Address: City: Zip: <br /> Contractor's Name: �J��1-'� S S Phone Number� -?�- ' SI� <br /> Mailing Address: (>> � ��� .� - ( �� City: � Zip: s��6� <br /> PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,275.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Munici al Sewer Connection/Disconnect/Repair($35.00 per stub) $ � ` O� <br /> P <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 /> WATER METERS must be picked up and paid for at City Hall. <br /> Water 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 /> REQUIlZED setback from sewer line=20' <br /> PERMIT 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 permit must be <br /> included for each well,sewer and water connection pemut requested. <br /> 3. PostaQe & 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 Oron or issuance of a Utility Permit, agrees to do all work fln �trict <br /> accordance with the ordinances of the City and the egu tions of the State of Minnesota, and certifies that all statements <br /> made on this application are coir�plete, tru c rrec . <br /> Signature of Applicant: Date: � � � <br />