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� CITY OF ORONO APPLICATION FOR UTILITY PERIO�IITS <br /> - ^ Box 66 (2750 Kelley Parkway) SEWER/WATER ��,c� <br /> � Crystal Bay, MN 55323 I �. <br /> � <br /> GENERAL 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 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 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 Deparfinent(249-4600)for utility stub as-built locations. DO NOT EXCAVATE <br /> IN ANY STREET AND DO NOT TAP ANY IvIAIN without express approval of the Public Works <br /> Departrnent. Issuance of a pernut 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: � / � �� ' � -c-' �"—� <br /> , <br /> Occupancy Type: Residential J Commercial <br /> Owner's Name: ,�il/��'/e%�� �.�: �. � '� Phone Number� �``%- `��`C�'S� <br /> � - l <br /> Mailing Address: ��' — � ' � �'- City: i� � �P <br /> Contractor's Name: � �_� Phone Numbe �' ` '� ' � � � <br /> ,- ,� ti_ 5����� — � f5 <br /> Mailin Address: - �" Ci �� <br /> g h'� � �p: 5:�'3 l.� <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) � $ <br /> pipe size_'Z inches; material :/ 5chedule 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(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 Building Code Division Surcharge of$.50 per permit must be <br /> included for each well,sewer and water connection pennit 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 Pernut, 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 /> Signature of Applicant:���i����,/�, %� _G�C�2� � �� <br /> Date: /� C/ l <br />