Laserfiche WebLink
� <br /> ' _ _ (Ur�i ited 2/12/O1) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <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. P ' ards 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 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(952)249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: y v � /�� S 9-r ��— <br /> Occupancy Type: , �/� Residential' ; Commercial <br /> Owner's Name: �'�, G E' L t'P 5�f" � t"t�l)�L'�'S � Phone Number: <br /> Mailing Address: �r` City: f S � Zip:� ,,,� <br /> , <br /> Contractor's Name: � ` ��'� U.�1 � �,-Phone N ber: "l% � ��'�'"> �C� � <br /> Mailing Address: C� � Ci ' � ._;� �J% <br /> i �j9� ty; � �p• � <br /> PERMIT TYPE , C= <br /> c _ <br /> Municipal Sewer onnection ($35.00 per stub) $ � "� <br /> pipe size inches; material �� Schedule 40 air tested; cast iron <br /> SAC Charge (200 rate $1,150.00) must accompany all sewer permit applications unless prepaid. <br /> If not prepaid, a sewer connection permit will not be issued. <br /> _ c` �.-` <br /> Municipal Water Connection ($35.00 per stub) $ '�� � <br /> pipe size � inches; material L--�opper; 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 /> PERMIT FEE CALCULATION r� �-� � <br /> 1. Subtotal of above permit requested $ / � ' <br /> 2. State Surchar�e $ .50 <br /> The State Buildin�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) $ ` C% ` � � <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 correct. <br /> . <br /> � • �_� G' 1 <br /> Signature of Applicant•. ' (,i-,4-Lr, �� <br /> Date: <br />