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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> . � Box 66 (2750 Kelley Parkway) SEWER/WATER i.-�Z�� <br /> Crystal Bay, MN 55323 <br />' GENERAL INFORMATION <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 /> 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 pernuts 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 /> � ' <br /> JOB SITE ADDRESS: � �� - � � <br /> Occupancy Type: Reside tial � Commercial <br /> Owner's Name: L�zS` � Phone Number: <br /> Mailing Address: City: 7ap: <br /> Contractor's Name: �.-,�.� � Phone umbe : .�/ " <br /> , ' <br /> Mailing Address: � City• L" 7ap: �S 3 73 <br /> � <br /> PERMIT TYPE _ �c� <br /> Municipal Sewer Connection ($35.00 per stub) $ -�; ~ <br /> pipe size � t� inches; material F��C-Schedule 40 air tested; cast iron <br /> SAC Chaxge ($1,050.00) must accompany all sewer permit applications unless prepaid. If not <br /> � prepaid, a sewer connection permit will not be issued. <br /> �! ci C�f <br /> Municipal Water Connection ($35.00 per stub) $ J � <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 /> REQUIItED setback from sewer line=20' <br /> PERMIT FEE CALCULATION �'�' <br /> 1. Subtotal of above permit requested $ `���y <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. Postage&Handlin� (Only mail-in applications) $ �36 <br /> 4. TOTAL PERNIIT FEE (add lines 1-3 above) $ ��, �Q <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 of Applicant: � �`-'� ����`�� Date:l � ���% <br />