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„ .R-_ CITY OF ORONO APPLICATION FOR UTILITY PERIVIITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <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 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 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 rec�uired. <br /> JOB SITE ADDRESS: 3 , � �`� � �`-� �� <br /> Occupancy Type: � Reside tial. Commercial <br /> Owner's Name: ��� '�, �� Phone Number: <br /> Mailing Address: - City: 7ap: <br /> Contractor's Name: � � Phone N mber: , G - � O <br /> Mailing Address: D City: � /► 7.�p: �-4� 7.� <br /> PERMIT TYPE <br /> � E3 CJ <br /> Municipal Sewer Co nection ($35.00 per stu� $ �S — <br /> pipe size inches; material � Schedule 40 air tested; cast iron <br /> SAC Charge ($1,0 0.00) must accompany all sewer pernut applications unless prepaid. If not <br /> � prepaid, a sewer connection permit will not be issued. � <br /> d C.-� <br /> Municipal Water Connection ($35.00 per stub) $ � S <br /> pipe size�mches; material copper; other - <br /> WATER MET`ER� must be picked up and paid for at City Ha1L <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 $_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 permit requested. <br /> 3. Posta�e& Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $_70�� U <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 eonect. <br /> f c ���-� <br /> Signature of Applicant� �` Date: <br />