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` r CITY� �;�ONO APPLICATION FOR UTILITY PERMITS <br /> , �;�'� <br /> Bnx 66 (2750 Kelley Parkway) SEWER/WATER � <br /> ' Crystal Bay,MN 5�323 �) ? <br /> ` �� <br /> � <br /> G <br /> EIVERAL 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 fees shown below. Permit cards will be sent <br /> by return mail the same day the application is received. <br /> 3. 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 connection 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 cover2d. Ca11249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: Ll�D ��Si �o�yLi,�,r�_ ,���:� <br /> Occupancy Type: `— Residential Commercial <br /> O`vner's Name: ���Uc:��s.� Phone Number: <br /> Mailing Address: �/G�� ��.s,� 1��;L�� �� City: ����� 7rp: <br /> Contractor's Name: C��c%,�- 1'��- Phone Number: ys�- S/s��-/�t'S <br /> Mailing Address: �'o �a.� �Jf' City:S%"��.•�s 7�p:_�s�3�� <br /> PERNIIT TYPE , <br /> Municipal Sewer Connection ($35.00 per stub) $ -`>> .�`C> <br /> pipe size � inches; material�/S�chedule 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 /> Municipal `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 Water Department(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 $ �� 'C�� <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 /> 3. PostaQe & Handlin� (Only mail-in applications) $ �� , � �� <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ "�� � ' � 1,"�� <br /> The undersi�ned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do <br /> all �vork in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete,true and correct. <br /> � Date: /����� <br /> Signature of Applicant:T�o�z, C/���2�� <br />