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<br />�� 1r. CITY OF ORONO � APPLICATION FOR UTILITY PERMITS � �'� �'��;�
<br /> J Box 66 (2750 Kelley Parkway) SEWER/WATER ��
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<br /> ` CrystalBay, MN 55323 _.�. . _ ��, h � ���.��� �ri�`���'����
<br /> GENERAL INFORMATION � � � �µ '� ���� �'�F
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<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. �
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<br /> h` 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. ' '�j
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<br /> � �,,,' ', 6. Contact the Public Works Department(473-7357)for utility stub as-built locations. DO NOT EXCAVATE �',;��,� ;,f
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<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. ������t��
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<br /> � 7. All work must be done in accordance with State Code requirements. �+���'�x�
<br /> :`���� 8. All work must be inspected before it is covered. Ca11473-7357. �`��`� � � � ��� { k�s �`� �
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<br />�` 24 hour notice required. �, �-.=' 3�,.��� �'
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<br /> JOB SITE ADDRESS: �v � � -�'�'- '��'�'�'�- T ���
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<br /> Occupancy Type: Reside tial Commercial �t�
<br /> ''�"x' Owner's Name: . � �' PhoneNumber: �� 7 ; � �� �f �� 7 ��
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<br /> r,�� �� Mailin Address: � �' -�7-��"'-,=._t- `;,��-���-+�.Ci : �� ���-�'�l
<br /> F 1 ,., g h' �-��-a--*��- 7�p: J � � � , y;
<br /> Rr ;� � Contractor's Name: .��-�� C-�=�t-- � Phone Number: L�- 7 7 �� %,� � ����
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<br /> � �:� �' Mailing Address: Z l/ �--4i►-�-�� City: ����r�� Zip:,!�j;� ? � �
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<br /> PERMIT TYPE � �
<br /> �' � Municipal Sewer Connection ($35.00 per stub) $ ` ``
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<br />��}� `� y pipe size �� inches; material� Schedule 40 air tested• cast iron A �` �'�
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<br /> k SAC Charge($950.00)must accompany all sewer permit applications unless prepaid. If not prepaid, ����` �
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<br />"�-� ` a sewer connection permit will not be issued. `�� � �'�
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<br /> � � Munici al Water Connection $35.00 er stub $ ��" �
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<br /> Pr � 1 pipe size inches; material copper; other �'a ��..�
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<br /> �;�< `: �'� WATER METERS must be picked up and paid for at City Hall. Fati ''���
<br /> (5/8" meters= $139.00; 3/4" meters= $191.00; 1" meters = $247.00) ���$�
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<br /> { ke Separate Plumbing Permit issued for water meter. ���
<br /> ;_:�'t Water meters must be set and sealed by Orono Water Department(473-7357)upon completion �, ��
<br /> � �. ' of ineter installation. `� ���
<br /> a °� REQUIRED minimum setbacks from drainfield and septic tanks= 75' � � `�-� &.��
<br /> 'S `���� REQUIRED setback from sewer line=20' �'�'�. ���' � '" � � ���
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<br /> �'' �� �� pERMIT FEE CALCULATION r '-� ' �`' �' � ��"""� "'
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<br /> � 1. Subtotal of above permit requested ��� ` ��� ' '�� �'��� �� $ '' � _��� �
<br /> r� � 2. State Surchar�e $ .50 ����'�
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<br /> �` The State Building Code Division Surcharge of$.50 per permit must be � ��,�.
<br /> r�� '�"� included for each well,sewer and water connection permit requested. �����
<br /> � ' 3. P o s t a g e & H a n d l i n� (O n l y m a i l-i n a p p l i c a t i o n s) $ 1.5 0 `�"����
<br /> ' � 4. TOTAL PERMIT FEE (add lines 1-3 above) $ `��>�
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<br /> - The undersi ned hereb a lies to the Ci of Orono for issuance of a Utili Permit a rees to do �� � �"'
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<br /> T�� �� ,; `; 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. `��������
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<br /> t �� Signature of Applicant: �� Date: / �s ,�` �
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