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. <br /> • CITY OF ORONO APPLICATION FOR UTILITY PERNIITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER �/ «�,2!�� <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <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 valid until you receive a permit card. <br /> 4. Work must not begin unless the permit card is ava'ilable on the job site. <br /> 5. Utility connection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(249-4600)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. Ca11249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: � X C � L. ����L L' C� t�C !-t d�J2 �� �� t�1`� <br /> Occupancy Type: X Residential Commercial <br /> Owner's Name: ��f��� Fi C^���� �� ����-��:=, Phone Number: <br /> Mailing Address: City: 7ap: <br /> Contractor's Name: �-�t l`^rl�1�1�1...' Q 1 C�� Phone Number: `7 3"3 �(��.� <br /> Mailing Address: �%.3 �j �-i!t�rt��r,,,� {�.,4�� City: o�vt i K t� 7ap: �J�3 Y�- <br /> PERMIT T'YPE <br /> Municipal Sewer Connection ($35.00 per stub) $ <br /> pipe size�inches; material � Schedule 40 air tested; cast iron <br /> SAC Charge ($1,050.00) 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= $130.00; 3/4" meters= $180.00; 1" meters= $240.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department(249-4600) upon completion <br /> 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 pemut must be <br /> included for each well,sewer and water connection permit requested. <br /> 3. Posta�e&Handling(Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERNIIT FEE (add lines 1-3 above) $ <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility 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 that all statements made on this application are complete, true and correct. <br /> (!/�) , <br /> Signature of Applicant:���� ��►�-�� Date: �LC��— U � <br />