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CITY OF ORONO APPLICATION FOR UTILITY PEP�iyIITS <br /> Bog 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 ��� �-='f <br /> , <br /> �. �% <br /> GEI`�ERAL 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. Pennit cards will be sent by <br /> 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 pernut card is available on the job site. <br /> 5. Utility connection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Depar[ment(473-7357)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«-ork must be inspected before it is covered. Ca11473-7357. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: ���`� �t�1..-�- {�.��- <br /> Occupancy Type: � Residential Commercial <br /> Owner's Name: Phone Number: <br /> Mailing Address: Z�F� �-�Il-� ��-� City: c>v�.� ,,t-; 7ap: <br /> Contractor's Name: c,w � � Phone Number: �3-2, �7 �i 7 <br /> Mailing Address: 1�=�:�� i w.k-►� - :1�.r�w�,5�c� �' �ty� Y'v�w��� , 7�p:S�3 � <br /> ItMIT TYPE <br /> ,��� unicipal Sewer Connection ($35.00 per stub) $ <br /> �h`�`" pipe size inches; material Schedule 40 air tested; cast iron <br /> SAC Charge ($1,050.00) must accompany all sewer permit applications unless prepaid. If not <br /> prepaid, a sewer connection permit will not be issued. <br /> Municipal Water 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 /> (5/8" meters = $130.00; 3/4" meters = $180.00; 1" meters= $240.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department(473-7357) 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 Building Code Division Surcharge of$.50 per permit must be <br /> included for each well,sewer and water connection pemut requested. <br /> 3. Postage & Handling (Only mail-in applications) $ 1.50 <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 <br /> all work 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 /> � ,�,�����'t� ,--�'_- � <br /> Si ature of A hcanf: � Date: 1 ' . <br /> � rr <br />