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. _ _ _..:�> , <br />_ . .� . _ . _ _ <br /> CITY OF ORONO APPLICATION FOR IITILITY PERMITS ' <br /> Box 66 (1335 So Brown Rd) SEWER WATER <br /> Crystal Bay, MN 55323 • <br /> ********************************************************�******************* <br /> i: You ma�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 /> Pezmit cards will be sent by return mail the same day the application is received. <br /> 3. Pe�its are nat valid imtil you reoeive a permit card. <br /> 4. Work must not begin unless the pernlit card is available on the job site. <br /> 5. Utility connection ��;ts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department (473-7357) for utility stub as-bu.ilt locations. <br /> DO NOT EXCAVATE IN ANY S'IRE�I' AND DO N(7r TAP ANY MAIN without express approval of the ': <br /> Public Works Department. Issuanoe 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 inspec�ed before it is oovered. Cal 1 473-7357. <br /> 24 htxir native i��i r�. <br /> *************************************************************************�* <br /> JOB SIT$ ADDRESS: ���C� L�,�" � / <br /> Occupancy Type: _��Residential Commercial <br /> � <br /> OWNER'S NAME: %; �- ,-, �� ` Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAI�II;:f./_�,-,-� l„�� ;�- � c B u s. P h o n e: <br /> Mailing Address: ; � � ,, ;,�;^.��< <�i City:� � , Zip: �����1. <br /> ****************************** ************************ *****`************** <br /> �3-� .c,2, PBItMIT TYPE AND F$E CULATION <br /> MIINICIPAI, SEWSR CONNECTION ( $�:8�6 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 �onnection permit will not be issued. <br /> 3�� � <br /> s <br /> MIINICIPAL WATER CONNECTION ($3�A-:�-0 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 f rom drainfield and septic tanks = 75 ' <br /> REQUIRED setback from sewer line = 20 ' <br /> *****************�********************************************************* <br /> l. Subtotal of above permit requested $ ='�l�' <br /> 2. State Surcharge . 50 <br /> The State Building Code Division Surcharge of .50 per permit must e <br /> included for each well, sewer and water connection permit requested. <br /> 3 . Postage � Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERIKIT FEE (add Iines 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 Minnesgta, and certifies that all statements made on this <br /> application are co�lete, true an correct. � <br /> ,� ( l <br /> Signature of Applicant: Date: != /�� - j�� <br /> _ . . : <br /> � ' <br /> r <br />