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(iJpdated 6/2/03) <br /> CITY �F ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal bay, MN 55323 <br /> . <br /> GENERAL INFORMATION <br /> 1. You may apply for utility pernuts 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 permit card is available on the job site. <br /> 5. Utility connection pemuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)far 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 gzant 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 ice re uired. <br /> � <br /> JOB SITE ADDRESS: � ��/Z� S��''�� �� <br /> Occupancy Type: � Residential _ /v Commercial <br /> Owner's Name: � �` Phone N mu ber: <br /> Mailing Address: City: Zip: <br /> Contractor's Name: -� ,��r � c� l�'�� Phone Number: 5� 7 <br /> Mailing Address:�,�>. � /� City: (,��Z � - Zip:�'��`3 z/ <br /> PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,275.00) $ `/11 (Set Rate) <br /> Sac Charge mt�st accompany all sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Connection/Disconn epair($35.00 per stub) $ �t <br /> pipe size , `( inches; material�� Schd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect epair ($35.00 per stub) $ �7� C�C� <br /> pipe size Z— 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 /> REQUIRED 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 Buiiding Code Division Surcharge of$.50 per pernut must be <br /> included for each well,sewer and water connection pernut requested. <br /> 3. Posta�e &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 �n �tri�t <br /> accardance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all staY�xri�nts <br /> made on this applicatio e complet true and c rrect. <br /> Signature of Appli nt: Date: �� '� <br />