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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> . - �Box 66 (2750 Kelley Parkway) SEWER/WATER �f� ,��7 <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 aze subject to the postage and handling fees shown below. Permit cards will be sent by <br /> retum 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(473-7357)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 wi�h State Code requirements. <br /> 8. All work must be inspected before it is covered. Ca11473-7357. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: --'� -7/ �����s �� �� � <br /> Occupancy Type: ��esidential Commercial <br /> Owner's Name: Phone Number: <br /> Mailing Address: S��� City: 7ip: <br /> Contractor's Name: C,�/:��� ���— Phone Number: y�%Y�.�� <br /> Mailing Address: �U m�o� d�'��.' City: 5�,.60�� 7ap: ,5:s=.��.� <br /> PERMIT TYPE ,� <br /> Municipal Sewer Connection ($35.00 per stub) � Sc'��£'� $ <br /> pipe size inches; material Schedule 40 air tested; cast iron <br /> SAC Charge ($1,000.00) 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) r�s cv�.�/�� $ <br /> pipe size inches; material copper; other <br /> WATER METERS must be picked up and paid for at City Hall. <br /> (5/8" meters= $139.00; 3/4" meters = $191.00; 1" meters= $247.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department(473-735'n 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 Surcharge $ .50 <br /> The State Building Code Division Surcharge of$.50 per permit must be <br /> inciuded for each well,sewer and water connection permit requested. <br /> 3. Postage & 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 a11 statements made on this application are complete, true and correct. <br /> Signature of Applicant� �� v Date: G ����f� <br /> � � <br />