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127��"1� <br /> • . CITY OF ORONO APPLICATION FOR UTILITY PERNIITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 � <br /> GENERAL INFORMATION <br /> 1. You may apply for utility percnits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fees shown below. Pemut 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 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. Ca11249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: <�7�-�l � < <-' ��,`�i-S �G'� C��� <br /> Occupancy Type: f�Resi ential Commercial <br /> Owner's Name• � Phone Number• <br /> Mailing Address: , City: 7ap: <br /> Contractor's Name:�. _ �� ��"1 ��;ci-L Phone mb : 1 —�='- -�_ <br /> Mailing Address: �'� ���� City: Oc_ 7.�p: 5��� �� <br /> PERMIT TYPE <br /> va <br /> Municipal Sewer Connection ($35.00 per stub) , $ �� �-- <br /> pipe size /� inches; material {'l�L--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 /> �:c5 <br /> Municipal Water Connection ($35.00 per stub)�� � $ _��.5 -- <br /> pipe size inches; material_�copper; 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 /> REQtJIRED 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 $ 7�' \` <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 pemut requested. <br /> 3. Postage&Handlin� (Only mail-in applications) $ 'I'SA�- <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ �7�5� <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Pernut, 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: �� '��/ �� <br />