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- Feb-06-2001 11:56am from-CITY OF ORONO +952Z484616 T-dT8 P.002/003 F-563 <br /> '' CITX OF 4ltON0 .A��'LICATION F+D12�1'TILITY PERMITS <br /> ' Box 66(2750 KeIley Parkway} SE'W'�12lWA,TER <br /> , Crystal Bay,Mlr' SS323 <br /> GENERAL YNFt?R T ON <br /> t. You may apply for utitity permits by mail or in pe�son at the City offiees. <br /> 2. Mailed in applications are subject to t6e postage and handiin�fees st�own below. permit cards wifl be sent <br /> by return mai!the sarne dsy tbe applicatioa is received. <br /> 3. Fermits sre not valid aat�yau recefve a pennit card. <br /> 4. Work must not bcgin ualess the pennit eard is available on the job site. <br /> S. Utiliry eonneceoa pecmits may be issue�to licensed contracwes only. <br /> 6. Contact the Pubtic Works Depamnrnt(249-4600)for utility stub as-bvilt locatiores. b0 NOT EXCAVATE <br /> IN ANY STR�Er AND DO NO'f rAP ANY MA1N without express apAcoval of the Public Works <br /> Department. Issuaaee Of a permit does not g�nt this approval. <br /> 7_ AA work must bt done in r►ccordnnce with 3taie Gode ceyu�ements. <br /> 8. All worEc me�st be inspeeted before it is covercd. CaI1249-4600. <br /> Z4 hoar nvtice required. � � <br /> �OB SI't�A,DDRESS: �:5 7 .�C y JQ�Nc�� o . <br /> Occupaacy'�pe: __�_Residential Commercial <br /> Owner's Name: �"'�f� N a v r- Phone Number: 9.��-,� -'y�3-/�Od <br /> Mailing Address: �S� tAsr .t,RK Sr,�'�r City:,c.l� �EI 7�;_ $a3,9/ <br /> Coutractor's Name:��-� �,�i97IF_ __77J>� P6on�N�ber: "�l- � <br /> �_� <br /> Maili�g Address: �' City:,s/�i9�CGy� 7�yp;���� <br /> PERMIT TYPE . <br /> Municipal Sevrer Connection {$35.00 per stub) $ _�� O'O <br /> pipe si�e_�'/ inchcs; material P'�fG Schedule 40 air tested; cast irun <br /> SAC Charge(2000 rate SI,t00,00)rtaust accomgany all sewer peimit applications unlcss prepaid. <br /> if not prepaid,a sewer connectian permit wili not be issued. <br /> Mun�cipal Water Coaacction($3S.d0 per stub} $ �,��, DO <br /> pipe size t inches; rnateria! ?� copper; vthtr <br /> t�1ATER METERS must be picked up and paid for at Ciry Hall. <br /> 'VVater meters musfi be set and seeled by Qrono Water Department(249-46QQ}upon completion <br /> of Aactar iastallatioa. <br /> REQLTIRED z�inimum setbacks from drainf`ield and septic t�ks=75' <br /> REQUIRED setback from sewer line=20' <br /> PE�2MT'Y'FE�CAY.CULATION � <br /> i. Subtotal vf above permit requested $ 7D.d� <br /> 2. State Surchar e $ .50 <br /> The State Building Code Division Surcherge of S,SO per peisnit must Fie <br /> inciuded for ei►ch wep,sewer and water conneetion pecraic eaquested. <br /> 3. Posta�e&Handling(Only mail-in applicacions) $ -�-3�- 3• � <br /> 4. TOTAL PERMIT FEE(2idd lines 1-3 above) $ �� !i p <br /> The euidersigned he�by appiies to ity ona for issuance of a Utility Pernut,agrees to do <br /> aIl work in strict accordance ' th o n ces of the Ciry and the regulations of the State of <br /> Minnesota,and certifies th al nt ade on this applicatioa are cvmplefe,true and eorrect. <br /> Signatuie o�Applicant: � Date: �' 7 �d� <br /> �/yI�E ,ac� � /=iN�j L (�R/�-� -T�U�- <br />