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FROM : PHONE N0. : 612 477 6208 Aug. 28 2001 08:31AM P2
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<br /> � C stal Ba. N� 55:323. ,. . ; . ;
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<br /> . GErT��NFORMATIUN . ,. , .
<br /> '' ' ' j: "�'"� -'`You xnay'`apply for utility perimits by inail or in�ierson.at tbe Ciry offxces'..`,. -
<br /> � 2; Mailed.in applications are subjeec to the postage and handling fee.shown betow. Perzz�it cards will be sent by
<br /> � �return mail the same day the application is received.
<br /> � 3; . permits are not vslid until you receive a per�'►t card.
<br /> 4: Wor1c must not begin unless the perniit card is ayailable on the job site.
<br /> 5. . Utiliry connection perrn�its may be issued fo licensed contraetors only:
<br /> G. Contact the Public Works bepartment (952-249-4600) for utitiry stub as-built locacions. DO NOT h
<br /> �XCAVATE IN AN�,' ST�ET.AND DO NOT TAP ANY N�.AIN without express approval of the public
<br /> T�
<br /> 'Works bepartment. Issuance of a permit does not grant this approvaL �
<br /> 7. 'All.wock must be done in accordance witb.StaCe Code requirements-: - CL� � \1�
<br /> 8. . All.wor.k must be inspected beforc it is covered. Cal�(952)249-4600: � � �`
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<br /> � 24 hour notice required. �
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<br /> JOB SXTE ADDRESS: 7� � / � ;�'l S �{'-
<br /> � Occupancy Ty�e: � Residential Commercia
<br /> Ow�ner's.Name: � �Cv Phoue N be� � � ��� �
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<br /> � Mailing A.ddress: - .3 City: 5 7�: 5S`r�y
<br /> Goz�tractor's Name: � �' Phone�T �e : (o� ���"G � '��'
<br /> Mailix�g Address: /��t�D �07�,P �cL /C� CitS':. � Z�; ..5,5�7 3
<br /> pERMIT TYPE
<br /> Municipal Sewer Connection($35.00 per stub) � $ 3 J ��v
<br /> , , . p i p e s i z e � i n c h e s; r x�a te r ial e-�'�hedule 40 air tested; cast iron
<br /> SAC Gharge(2000 xate $1,150.00) must accoz�r�pany all sewer pe�nit applications unless pzepaid.
<br /> If not prepaid, a sewer connection permit wial not be issued.
<br /> 1Vlunicipal Water Connection ($35.00 per stub) $ J��- ��
<br /> pipe size�_inches; material �copper; other
<br /> WATE�t METERS must be picked u� and paid for. at City Hall:
<br /> Wa'ter meters must be set and sealed b�► Orono Water Department (952-249-4600) upon
<br /> com.pletion of ineter installation.
<br /> REQUIRED minimurz�setbacks from�drain field and septic tanks =75'
<br /> REQUIRED setback.from sewer line=20'
<br /> PERMIT FEE CALCYJLAT�ON ' �d ��
<br /> 1. Subtotal of above permit requested $
<br /> . � 2: State SuxcharQe $ .50
<br /> . The State Suilding Code Division Surcharge of�.50 per permit must be �
<br /> included for eAch well,sewer.and water connecCion permit requested.
<br /> 3:. : osta e & andlin (Only mail-in applications) $ �� .
<br /> 4.. ..�.� TOT'AL PERNZZ?FEE (add lines 1=3 above) $ �"fD • ��J
<br /> The undersigned hereby applies to the City of Orono �oz issuance of a Utility Fermit, agrees to do
<br /> all work in strict accorda�ee with the ordiz�az�ces of the City and the regulations o�the State of
<br /> Minnesota, and certifies that aIl statements znade on this application are.cozx�,plete,true and conect.
<br /> Si�nature of Applicant: _ + ` Date: ���� ��
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