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CITY OF ORONO , . APPLICATION FOR DTILITY PERMITS <br /> Box 66 (1335 So Brown Rd) SEWER WATER <br /> Crystal Bay, MN 55323 <br /> *************************�************�************************************ -r <br /> x I: You ma�y}a p�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 /> Permit cards will be sent by return mail the same day the applica.tion is received. <br /> 3. P�mits are nat valid imtil ynu reoeive a pern�it c�xd. <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: -' <br /> DO NC7I' F�CAVATE IN ANY SZREE'r AND DO NOT 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 wi.th State Code requirements. <br /> 8. All work must be inspected before it is covered. Call 473-7357. <br /> 24 haur notiae required. <br /> ************************************************************************�** <br /> JOB SITE ADDRESS: l.�l� ��--E=�� � � ' <br /> Occupancy Type: Resident' 1 Commercial <br /> OWNER'S Nl�ML: S�- ���„ Phone No. : <br /> Mailing Address: , City: � �- _ <br /> r / <br /> ` �- <br /> CONTRACTOR'S NAI�II;: i %- � Bus . Phone: i,�`/�• -����� <br /> Mailing Address: �/ City: } r,-a=�� - Zip: .SS�,��`'s � <br /> *******************************************************�*** ***`�********** <br /> _____. PERMIT TYPE AND FEE CALCIILATION <br /> MIINICIPAL SEWER CONNECTION ($30. 00 per stub) $ <br /> pipe size inches; material PVC (on sand fill) ; cast iron <br /> SAC Charge ( $700.00 ) must accompany alI sewer permit applications unless <br /> prepaid. If not prepaid, a sewer connection permit will not be issued. <br /> MDNICIPAL 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 campletion 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 $ <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 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 co�lete, true and correct. <br /> , , . � .� � "�%-�'� � Date: � - 7 ��'�� <br /> Signature of Applicant: ,�% � ' <br /> , , <br /> . i ,' . <br /> x ' <br />