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CITY OF ORONO APPLICATION FOR UTILITY PERNIITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 <br /> �� - � - ���-�- <br /> GENERAL INFORMATION � y�7 �j � �J�..�— <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. 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. �� �������� ( ( r_ D � ! q�� <br /> 4. Work must not begin unless the permit card is available on the job site. �G' � O <br /> 5. Utility connection permits may be issued to licensed contractors oniy. <br /> 6. Contact the Public Works Department(249-4600)for utiliry 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: � ��^ ST� � <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: y��Q �S'TI''UG�/S/�i� Phone Number: �L�/— 04 <br /> Mailing Address:_ ,SS 7l �Q'� ��� City: fi' 7ap: ,S"'S'��O <br /> Contractor's Name: Phone Number: <br /> Mailing Address: City: 7ap; <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ 1� <br /> pipe size�s�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) $��� � _� <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 /> REQIJIRED minimum setbacks from drainfield and septic tanks= 75' <br /> REQUIItED setback from sewer line=20' <br /> PERMIT FEE CALCULATION /��. dO <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ �8-� <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) $ _�.,.5.0— <br /> 4. TOTAL PERNIIT FEE (add lines 1-3 above) $ /.�O. Ol� <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 /> � <br /> Signature of Applicant: Date: ���G `� � <br />