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CITY OF ORONO APPLICATION FOR UTILIT�'PER1dIITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> . . Crystal Bay, MN 55323 � � �� <br /> GENERAL INFORMATION � p�� � I <br /> 1. You may apply for utility pemuts by mail or in person at the City offices. k�'" ��4,�-' ��.3 D� <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 available on the job site. <br /> 5. Utility connection permits 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 /> Departrnent. Issuance of a pernut 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: :;� `�.�.? ,l'�ri,,-r�,.�•l� � <br /> Occupancy Type: r/ Residential Commercial <br /> Owner's Name: ,T�'L ,�L�„ze, Phone Number:_�;' 7-�G G�� <br /> Mailing Address: City: 7�p: <br /> Contractor's Name: �, ,�%� /��!-� �-�- Phone Number: �f y7- �o.?/ <br /> Mailing Address:_/'�Us U aG.-�'ti�' City:��-i�«,� 7ap: ,S f'376 <br /> PERMIT TYPE <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 picke and paid for at City Hall. <br /> � - . <br /> (5/8" meters= $130.00; ° 3/�ters = $180.00; 1" meters = $240.00) <br /> Separate Plumbing Permit issued for at eter. <br /> Water meters must be set and sealed by Orono Water Department(249-4600) upon completion <br /> of ineter installation. ��'�, G.� <br /> REQUIRED minimum setbacks from drainfield and septic tanks= 75' <br /> REQUIRED setback from sewer line=20' 3S-s� <br /> -----_ _---._ <br /> PERMIT FEE CALCULATION � � �' S� <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surcharee $ .50 <br /> The State Building Code Division Surcharge of$.50 per pernut must be <br /> included for each well,sewer and water connection pemut requested. <br /> 3. Postage&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 /> Signature ofApplicant:�/f.e�i�,-�. ���.�e.c� Date: �f- � y '�'/ <br />