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. _ CITY OF ORONO APPLICATION FOR UTILITY PERMITS � ��7�� <br /> Boz 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 <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 /> 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 pernlits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Departrnent(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 /> 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: � ��-� -3 C.�—vt�� ..� v <br /> Occupancy Type: Residential Commercial <br /> Owner's Name• <� vL Phone Number: <br /> Mailing Address: _ City: 7�p: <br /> Contractor's Name: � �-,.-� � Phone�umber: �77- /„ ;-��' <br /> Mailing Address: �. City: C�� 7.�p: 5 S� �3 <br /> PERMIT TYPE � <br /> Municipal Sewer Connection ($35.00 per stubJ ,,. $ �`� �""� <br /> pipe size inches; material ��L—Schedule 40 air tested; cast iron <br /> SAC Charge ($1,050.00) must accompany a11 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) ,h $ �,� Lcl <br /> pipe size inches; material j r' copper; other - <br /> WATER METERS must be picked up and paid for at City Ha11. <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 $ 'Q.� L't; <br /> 2. State Surchar�e $ .50 <br /> 'The State Building Code Division Surcharge of$.50 per pennit must be <br /> included for each well,sewer and water connection pemut requested. <br /> 3. Posta�e&Handlin�(Only mail-in applications) $ �-59 <br /> 4. TOTAL PERMIT FEE (add lines ]-3 above) $ `7C'��SU <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 /> ., j _ <br /> Signature of Applicant: Date: �� - % i��1l� <br />