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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (1335 So Brown Rd) � ` SEWER WATER <br /> Crystal Bay, MN 55323 <br /> **************************�************************************************ <br /> I:You mainy a�pply�or 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. <br /> Pernut cards will be sent by return mail the sam�e day the application is received. <br /> 3. P�emnits are mt valid im�til yai reoeive a ��;t c�rd. <br /> 4. Work must not begin unless the pernut 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 Departme.nt (473-7357) for utility stub as-built locations. <br /> Dp NOT EXCAVATE IN ANY STRE�r AND DO NCyr TAP ANY MAIN without express approval of the <br /> Public Works 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. Al1 work must be inspected before it is covered. Call 473-7357. <br /> 24 hair no�t.ic�e required. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: � 5 <br /> Occupancy Type: Resid nt' Commercial <br /> OWNER'S NAME: Phone No. : <br /> Mailing Address: City: /��i,�� • <br /> CONTRACTOR'S NAME: � � Bus. Phone: y����-�y�s � <br /> Mailing Address: City: ' ,Zip: �:�r5 <br /> ******************* *************************************** ***��********** <br /> �s',dz, PSRMIT TYPE AND FEE CALCIILATION <br /> MIINICIPAL SEWSR CONNECTION (�`3-9-:$fl per stub) $ <br /> pipe size inches; material PVC (on sand fill ) ; cast iron <br /> SAC Charge ($700.00) must accompany all sewer permit applications unless <br /> prepaid. If not prepaid, a sewer connection permit will not be issued. <br /> MIINICIPAL WATER CONNECTION ($30. 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 = $133. 00; 3/4" meters = $181. 00; 1" meters = $235. 00 ) <br /> Water meters must be set and sealed by Orono Water Department (473-7357) <br /> upon co�pletion of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75 ' <br /> REQUIRED setback from sewer line = 20 ' <br /> *************************************************************************** <br /> l. Subtotal of above permit requested $ <br /> 2. State Surcharge .50 <br /> The State Building Code Division Surcharge of .50 per permit must be <br /> included for each well, sewer and water connection permit requested. <br /> 3 . Postage � Handling (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 Utility Permit, <br /> agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this <br /> application are complete, true and correct. <br /> Signature of Applicant:_����it-��,L��i�''�'s���: <br /> Date: c; -�l �s <br /> -� <br />