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(Ur J�ted 2/12/O1) <br /> 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 fee 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 permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department (952-249-4600) for utility stub as-built locations. DO NOT <br /> EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public <br /> Works Deparhnent. 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(952)249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: �� I l G� �,; �) �`; r c, ;`��,-��y�—� <br /> Occupancy Type: 1/'� Residential Commercial <br /> Owner's Name: �,,����(►'�-'� �> `�t Jl.�. ���> Phone Number: <br /> Mailing Address: City: � :.�L.- > � 7�p: � <br /> Contractor's Name: �r' � `i �� .J� � Phone Ny}n e • ^� � �� � `-�Z� � <br /> Mailing Address: � � 7 �7 - �/�. f'�.- City: d C°� -t� 7ip: j j �j <br /> � � <br /> PERMIT TYPE � � �� r� <br /> Municipal Sewer Connection ($35.00 per stub) $ ' <br /> pipe size�mches; material ✓Schedule 40 air tested; cast iron <br /> SAC Charge (2000 fate $l,l�0.00) must accompany all sewer permit applications unless prepaid. <br /> If not prepaid, a sewer connection permit will not be issued. <br /> L <br /> Municipal Water Connection ($35.00 per stub) $ �'> � C <br /> pipe size�inches; material copper; other <br /> WATER METERS must be picked up and paid for at City Hall. <br /> Water meters must be set and sealed by Orono Water Department (952-249-4600) upon <br /> completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks= 75' <br /> REQUIRED setback from sewer line =20' <br /> PERIVIIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ �L � �Z <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 & Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ �� ' �G <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 /> _ �- - - � . �_ <br /> Signature of Applican� '� L -Q� Date: � � � � <br />