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. �ITY OF ORONO APPLICATION FOR UTILITY PERNIITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER 1 -Z;Z ��� <br /> Crystal Bay, MN 55383 <br /> GENERAL INFORMATION <br /> i. You may apply for utility pemuts 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 pernut card is available on the job site. <br /> 5. Utility connection pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Departrnent(249-4600)for utiliry stub as-built locations. DO NOT EXCAVATE <br /> IN ANY STREET AND DO NOT TAP ANY MAIN without e�cpress 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. Call 249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: -� 7�`i�"' L-z-'��c� _ Z��� C� <br /> Occupancy Type: �_Residential Commercial <br /> Owner's Name: ;�D �� � Phone Number• <br /> Mailing Address: _ City: 7ap: <br /> Contractor's Name: 2�-,--� � � Phone Nu��: �7 7—G �-�?� <br /> Mailing Address: �:�� :��c� City: 7ap: �i� � '��J3 <br /> PERMIT TYPE _��� <br /> Municipal Sewer Connection ($35.00 per stub $ �`� <br /> pi pe size�inches; material ���LSchedule 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 /> =,c <br /> Municipal Water Connection ($35.00 per stub) ,i $ �`� <br /> pi pe size inches; material �' cop�er; 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 --7 , c n <br /> 1. 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 &Handlin� (Only mail-in applications) $ �LL <br /> 4. TOTAL PERNIIT FEE (add lines 1-3 above) $ 7C, S O <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 conect. <br /> Signature�f Apnc�ant: <br /> s����'L`iJ�7 -�J—�,"--' Date: � � '���— 1C� <br />