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� <br /> D�c-04-2001 12:44pm Prom{ITY OF ORONO +D6224o4816 T-1oT P•001/001 F-306 <br /> �u�+uY��u�ia`�ui� <br /> CITY OF ORONO APY'L�CATION FQR UITLTTY PER,NJITS <br /> BoY 6d(2750 KeUoy Parlcwa�y) S�wER/wATER <br /> Crystal Br�y,MN 5�323 <br /> [`R1�i2�1��I,iNFOS1N'�TU�N <br /> t. You�naY aPR1Y for utilEty parmits by rnail or�:persan at the City afficos. <br /> 2, MaUed ia applicsti�s are aubjeci to the postage aaci Lanmiag fte shown below. Parnit cards will ba sea�t by <br /> return mail tha same day tha application is recalved <br /> 3, Pecm[b ara not v�1W unttl you raoefve a potmit eard. <br /> 4, 'Wark must not be�in unloss�e permlt aerd�a svdlable an the job site. <br /> S. Utiltty coanxdan permits inap�be iss�od to Uc�nsed camactors onty. <br /> 6, ContAct the Public Works Deparimeat (95?-249-�4600) for utt�ity stub as-bvilt lacaeions. DQ NQT <br /> EXCAVA'!'E IN ANY STREEI'AND DO NGT TAP ANY MAIN wltl►out express approval of tha Pubiic <br /> Works DepartmeW. Issuaace of a pera►it doas not @ant this opproval. <br /> 7. All w+xk muet be clone in accordenee.vith Stme Code requir�aea#s. <br /> , 8. AA woslc must be i�speated betare it is covera l, Ca1I(952)349-4600. <br /> TA hour aoUce req�tred. <br /> aa8 sT�`T�AD�Es�:v���1S e�Qa�a re <br /> p�q��'j�r�: ,� R.�sid�nti�t ll Commercial <br /> Owuer'�N�a�i d.�� ' Phoae N�►b�r: <br /> Ma�n�Adds�'�, — • Citptl��o Ti���� � <br /> Contractar'aNu�pe: PhoucNumbe�:,��,-q_� <br /> MsiIiung Address. ity:'M�c�c��d 7� �;5�4,5 <br /> P�12MYT'I'YPT <br /> Munidpsel Sewer Conaectloa($35.00 per stub) $ • <br /> 11����4 pipe si�e inches; matcrial,,,,_,Schcdule 40 air tested; cast iron <br /> �'� SAC Charge(200Q rate$1,150.Q0)muat acco�nzpaay all stwer pmmit applic�tions unlcss prepaid <br /> �j � If not Frap�id,a sew�er co�.ectian permit will�wt be issued. <br /> � Munlclpel'�itater Connection(�35.00 per stub) $ ���Ob <br /> pipe aize�_inahes: mat�rial�'►,�.capper; other <br /> WATER METERS mustt bc picla�d up and paii i for at Ci#y Ha11. <br /> Water metera a�ast be set and seated by tlrnna Water Deparbmcnt (952-?A9-4600} apon <br /> compledan of m�ter�ux#I1xtlon. <br /> REQL7Y1��aunimum sctbacks from dr�in fiald and segtic tat�k.s=?5' <br /> REQUYRE�ectbeck�rom saw�r line=20' <br /> PF�I3lYx�'FEFr�ALCULATION <br /> 1. 9c�btotal of abovc permit raquc�tcd $ J��O <br /> 2. �tate.Surcl�arsx� $ .50 <br /> Tha State Building Codt Y7�ivta�on 3urcb�ga ai'�.SO per peamit must be <br /> inaluded for eaah well,sewer aad water�onne��iou permit raquestuE. <br /> 3. Posc�ge.��aaaiinA(Oniy mail-in app�Ications) $_ �,i9- . <br /> i <br /> 4. TQTA.L�PERMIT FEE(ndd linos 1-3 above} ��, <br /> ?he uadcrsi�aed her�by applies to thc City of�hona for issuaacc af a Utility Pern�it,agrccs to do <br /> all work in striGt�cx,ordsute with the ordinan�:cs of the City and tht rtgulations of the Statc Qf <br /> 1Viinnesot�and certifias t1�at all stataments rnade on this'application ara eamplete,true and correct. <br /> s��ofappt�G��.�izm����,�,�P�, n��: �-ao� <br />