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Doc-A4-2�D1 12:44pm Fram-CITY OF ORONO +�6Y24o4616 T-2�T P.001/001 F-306 <br /> ' E4�4�11pN!./t4N1� <br /> CITY OF ORONO APPLICATION FQR iJTILITY PERMTTS <br /> Bax 66(2750 Kalley Parkway) SEWEIt/WATER <br /> Crysta!Bay,M1Y SS�23 <br /> �ENER,� INFORMA'�YON <br /> 1. Ycu may apply for utility permits by mail or u:persan at the City offices. <br /> 2, Mailed in applications are subject to the postage and handlin�fee showa below. Perrnit cards wilt be sent by <br /> return mail tha same day the application is recc;ived. <br /> 3. Permits are not valid until yon reoeive a permit card. <br /> 4. Work must nat begin unless tt�e pernut cerd�a available on the job site, <br /> 5. Utility connection perraits may be issued to licensed contrt�ctors only. <br /> 6, Coatact the Public Works Deparhneat (95?-249-4600) for utility stub as-bvilt locations. DQ NQT <br /> EXCAVAT'E IN ANY STREE'T AND DO NGT TAP ANY MA1N without express approval of the Public <br /> Work's Departmani. [ssunnce of a pemtit does not�ant this approval. <br /> 7. All we�k muai ba done in accnrdance with Stai o Code requircmeats. <br /> , 8. AII work mtist be iaspocted before it is coveral. CaII(452)�49-4600. <br /> 24 hour notice reqaired. <br /> Joa sr�����ss:�(�G� " , <br /> Qcraip�acy'I�pe� � Residential � Commercial <br /> Ovraer's N�t: �`l m�:��.� � � � Phone Numbcr: <br /> Mailtn�Addre��:�l��t -{��k�c. i.v-� � Cit���:��,-�� <br /> Contractor'a Naip - Phoae Nuaeber:�� -� - - ' � <br /> Mailing Addrtss:'l--�-,1 .-�,��, ` City: 5�.�,,.. T�p:, �-,� <br /> P�RtVIYT TYP� <br /> Municipal Sewer Connection (�35.QQ per stub) $ <br /> 1/���� pipe size�'_inches; m�terial,�Schcdule 40 e,ir tested; cast iron <br />''�""�' SAC Charge(2400 rate$1�150.00)must acconip�ny all stwer ptscnit applications unless pnepaid. <br />�+ �S If not grepaid,a sewer connectian permit will�wt be issued. <br /> .r <br /> 1Vtuntcipal'1�Ater Connection($35.00 per stub) , $ <br /> pipc aiu inah ; matcrial _,,,.copger; other <br /> WATER METERS m t picked up and pai�i for at City Ha11. <br /> Water meters muat be ct s�n� sealed by (Irono Water Department (9S�-?A9-4600) ugon <br /> compleHon of ineter tai t�on. <br /> REQL�.Ia nim satbacks from drain�ield and segtic tanks=75' <br /> REQCJ setback$ sewer line=�Q' <br /> P�R��'F�FE�AL��L�iTL4�t <br /> 1. Subtotal of above perm,it requestcd $ ?��_,��� _ <br /> 2. Statc.Surc�e $ .�0 <br /> Tha Stato Building Codc Divisinn Surch�rgn o�'$.SU per permit must ba <br /> iaoladed for eacah well,sewer and water eounec:tio�permit rcquested. <br /> 3. Postage.8��Samdling(Orily mail-in applications) � � <br /> 4. TOTA.L PERMIT FEE(add lines 1-3 above) $ .�ti,.�; <br /> The u�ndersigned hcreby appIics to the Ciry of�lrono for issuauct af a Utility Pernut,agrccs to do <br /> �11 worlc in StriCi �icxordmxce with thc ordinan�:cs of the Cifiy and the regulations of th� State of <br /> Muuicsota�and certi�ies that all statemcnts made on this�application are eomplete,true ar�d coaect. <br /> Y � . / <br /> Signature of Applicant` I �U�,� .l'�(�-r-�,c, Date� �-��.--cx.__�,_ <br />