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• - (Updated 1/5/04) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORNIATION <br /> 1. You may apply for utility pemuts 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 pernut card is available on the job site. <br /> 5. Utility comiection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Deparmzent(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public Works De�artment. 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. Call(952)249-4600, 24 hour notice required. <br /> JOB SITE ADDRESS: � b � �-�t� 1� � <br /> Occupancy Type: Residenti 1 Commercial <br /> Owner's Name: o� < «�oc, ��- e�3,�,� Phone Number: y�/-- d5�� <br /> Mailing Address: City: Zip: <br /> Contractor's Name:_I_ _ _ (�►���� Z.Y c_ �-e.. Phone Numb r:�y�d) yyi�-dy�� <br /> Mailing Address: 7���oSr�i``�' -. City:��b Zip: �SSvS <br /> PERMIT TYPE ❑Connections ❑Repairs �Discomlect (Check One) <br /> SAC Charge (2003 rate $1,350.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> ... <br /> Municipal Sewer Connectio�Disconnec Repair ($35.00 per stub) $ <br /> pipe size inches; Schd 40 air tested; cast iron <br /> Municipal Water Connec on/Disconnect/ epair ($35.00 per stub) $ <br /> pipe size inches; m ria 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 Building Code Division Surcharge of$.50 per pemut must be <br /> included for each well,sewer and water connection pernut requested. <br /> 3. Posta�e & Handling(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 in strict <br /> accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements <br /> made on this application are comp te, true �d corr�ct. <br /> , <br /> , <br /> Signature of Applicant: �c Date: 7`��^� <br />