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�"''� .tS",2 o,G <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS �a�3a� <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER �� <br /> Crystal Bay, MN 55323 <br /> � <br /> GENERAL INFORMATION �' <br /> 1. You may apply for utility permits by mail or in person at the City offices. 1 <br /> 2. Mailed in applications are subject to the postage and handling fees shown below. Permit cards will be sent ^ <br /> by return mail the same day the application is :eccived. � <br /> 3. Permits are not valid until you receive a per�►it car�l. � <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 /> _ <br /> 7. All work must be done in accordance with State Code requirements. ' <br /> 8. All work must Ue inspected before it is covered. Call 473-7357. . <br /> 24 hour notice required. � <br /> JOB SITE ADDRESS: � �U ��'�'� s% <br /> Occupancy Type: ��Residential Commercial <br /> Owner's Na:ne: �v� �,�/ s��sl,/�T PhoneNumber: <br /> Mailing Address: ? 7 0 ��� s�` City:(��Zd�v 7ip: <br /> Contractor's Name: Gs'�2G �z✓' /�i�'�-� b PhoneNumber: <br /> Mailing Address: �',Zo �sl/�'J/�� City: l�,�e /�� 7ip:�-r-� � - <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ <br /> pipe size inches; material PVC (on sand fill); cast iron <br /> SAC Charge ($750.00) must accompany all sewer permit applications unless prepaid. If not <br /> prepaid, 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 = $133.00; 3/4" meters = $181.00; 1" meters = $235.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department (473-7357) upon <br /> completion of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .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 & Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to <br /> do all work in strict accordance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Signature of Applican . �e� b "� ^� _3 <br />