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1� ' _ <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> � ! Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> ` �' <br /> Crystal Bay, MN 55323 <br /> ,, �'. L-�� <br /> GENERAL INFORMATIOIv � l ` <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 vatid 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 Department(473-7357)for utility stub as-built locations. DO NOT EXCAVATE � � <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. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Ca11473-7357. ( <br /> 24 hour notice required. ' , ' <br /> JOB SITE ADDRESS: � � �%��= �-����4� � ��' ��� � '� �'�.�-� <br /> Occupancy Type:� � Residential Commercial ` <br /> Owner's Name: ��y \��S C�: c?� �- �` Phone Number: �-(�{�! �� � �� L; <br /> Mailing Address: City: 7;p: <br /> Contractor's Name• ` ° �N `'�� Phone Nu ber:�� �- �--� � "t--` ��3��°� <br /> Mailing Address: �: � - �S'� �a� ' - City: `,��� '�'c,�L.�,� Zip: ���t� f <br /> ;Ft <br /> PERMIT TYPE , ,,�� <br /> Municipal Sewer Connection ($35.00 per stub� $ � � <br /> pipe size (,.� inches; material Schedule 40 air tested; cast iron : <br /> SAC Charge($950.�must accompany all sewer permit applications unless prepaid. If not prepaid, � <br /> 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= $139.00; 3/4" meters= $191.00; 1" meters= $247.00) '; <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department(473-7357)upon completion ``� <br /> ':r' <br /> of ineter installation. - <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> REQUIRED setback from sewer line=20' <br /> �� <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ � <br /> 2. State Surcharee $ .50 <br /> � <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each well,sewer and water cormection permit requested. ' <br /> 3. Postage & Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ <br /> ';;� <br /> The undersigned hereby applies to the City of Orono for issuance of a Utiliiy Permit, 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 th a11 statements made on this application are complete,true and correct. <br /> _ � <br /> Signature of Applican c Date: `u <br /> . , �.;. <br />