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CITY OF ORONO APPLICATION FOR UTILITY PERNIITS <br /> Bog 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 ���� � <br /> _ U._ a�i-c� <br /> GENERAL INFORMATION # ��-{-S5 �P�9 <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 fees shown below. Pernut 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. ��ZC!�����c���'�"� <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connection pemuts 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 pernut 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�� ��� � ' � <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: �-rev � e' '%rrf�S�� PhoneNumber: �.y! � �`'/OD <br /> Mailing Address: S'�f 1 �f1t/,�,�j�S'' /},r/'e � City: !�' 7�p: _ S��D <br /> Contractor's Name: Phone Number: <br /> Mailing Address:_ S/g/�� City: 7ip: �5��� <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ <br /> pipe size inches; material 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 /> Municipal Water Connection ($35.00 per stub) $ f.3d. d 0 <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 /> 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 $ i.3�• �d <br /> 2. State Surchar�e $ ��- <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. Postage& Handling(Only mail-in applications) $ 1,50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ /�� F <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 a�plication are complete, true and conect. <br /> Signature of Applicant: Date: �� �� � �� <br />