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(I7r:iated 2/12/O1) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERIVIITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> �rystal Bay, MN 55323 <br /> , GE1�tERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications aze subject to the postage and handling fee 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 (952-249-4600) for utility stub as-built locations. DO NOT <br /> EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public <br /> Works Department. Issuance of a permit does not grant this approvaL <br /> 7. Ail work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call(952)249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: O G�� ' �LJ � <br /> Occupancy Type: Residential Commerci 1 <br /> Owner's Name: _,�,�i {��_ Phone Number: y 7� /r� 7 <br /> Mailing Address: .� City: 7�: <br /> Contractor's Name: ,,.�s;c� Phone N ber: 1d-SSq-.� o� <br /> Mailing Address: a ��^ �. City: � Zip: S" <br /> : ,.� <br /> �,� PERMIT TYPE . <br /> (� 1�lunicipal Sewer Connection ($35.00 per stub) $ <br /> � pipe size '� inches; material x Schedule 40 air tested; cast iron <br /> SAC Charge (2000 rate $1,150.00) must accompany all sewer permit applications unless prepaid. <br /> � If not prepaid, a sewer connection permit�vill 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 /> Water meters must be set and sealed by Orono Water Department (952-249-4600) upon <br /> completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field 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 Buildin�Code Division Surcharge of$.50 per permit must be <br /> included for each well,sewer and water connection permit requested. <br /> 3. Posta�e & 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 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 s ement ma on t ' application are complete,true and correct. <br /> Signature of Applicant: Date: ��� -v� <br />