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(iJr:;ated 2/12/O1) <br /> , CITY OF ORONO APPLICATION FOR UTILITY PERIVIITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER �r_ ( 1� <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 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 AN�STREET AND DO NOT TAP ANY MAIN without express approval of the Public <br /> Works Depariment. Issuance of a permit does not grantthis 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. Call(952)249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: � `-�S \ �v ; �� � � R`�! <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: E?,•�r��s�e t 1 h�,,.,., f `a Phone Number: <br /> Mailing Address: City: 7�: <br /> Contractor's Name: L.�.r,.`:r Cc,,�e ,� Phone Number: °� 5'a-�( � �.- a,3 � � <br /> Mailing Address: S vg�i S ��e_� ..-�� �r City: m ,����, � 7ip: S 5� 3 tr�{ <br /> PERMIT TYPE . <br /> Municipal Sewer Connection ($35.00 per stub) $ �3 � -�' `� <br /> pipe size inches; material 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 will not be issued. <br /> Municipal Water Connection ($35.00 per stub) $ -�'�� � G <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 /> l. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 <br /> The State Building Code Division Surcharge of$.50 per permit 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 PERMIT FEE (add lines 1-3 above) $ �Ca_ J�' <br /> —� <br /> The undersi�ned 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 of Applicant: ��^� `�,� �- Date: 1 t – a C� � � 1 <br />