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CITY OF ORONO APPLICATION FOR UTILITY PERMITS /� <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER � <br /> Crystal Bay,MN 55323 �� /� <br /> ^ � <br /> GEIYERAL INFORMATIOIY ����� <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 fees shown below. Permit cards will be sent <br /> by 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 /> 5. Utility co�nection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(249-4600)for utility stub as-built locations. DO NOT EXCAVATE <br /> IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works <br /> 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. Ca11249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: d���lj �`��='/'�v�v` y`} � ������� ��� <br /> Occupancy Type: � Residential Commercial ��( <br /> Owner's Name: /-���r� /��.r��,�.c� Phone Number: ��� �` �`5��� <br /> , <br /> Mailing Address:�.So £'/,'.s���� ��L �� City: G.c?v�v' Z�: <br /> Contractor's Name: ��'�l��-- �.�-�- Phone Number: �/sd� %/6= /�y.� <br /> 1�Iailing Address: �� ,��,�c ��� City:S;�.�f✓�.L Zip: SS_���' <br /> PERII�IIT TYPE - <br /> Municipal Sewer C/�nnection ($35.00 per stub) $ `��>`� ' �`�� <br /> pipe size ` inches; material Schedule 40 air tested; cast iron <br /> SAC Charge (2000 rate $1,100.00) must accompany all sewer permit applications unless prepaid. <br /> If not prepaid, a sewer connection permit will not be issued. <br /> 1�Iunicipal `Vater 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 /> �Vater meters must be set and sealed by Orono WaterDepartment(249-4600)upon completion <br /> of ineter installation. <br /> REQUIRED minimum setbacks from drainfield 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 Buildin�Code Division Surchar�e of$.50 per permit must be <br /> included for each well, sewer and water connection permit requested. <br /> ;. Postaae & Handlin� (Only mail-in applications) $ �� -- ' <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ �5 ' � � � <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do <br /> all �cork in strict accordance with the ordinances of the City and the regulations of the State of <br /> �-linnesota, and certifies that all statements made on this application are complete,true and conect. <br /> Signature of Applicant:� G���%��— Date: /���� <br />