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FROM : PHONE N0. : 612 477 6208 Aug. 28 2001 a8:31AM P3
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<br /> -CTi,�'XOF�ORONO A,�'FLYCATION=°�"� , Y.�ERMiTS .
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<br /> �� �� �" � Box 66'(2750 Kel�ey ParkwaX) � : �.
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<br /> `.- ' . . :, ,. ,Crystal.Bay;MN 'S5323;:::: �. . . . : , ..
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<br /> - c:F.y�ERAL�IN�'ORN�ATYON: . . �. ,.. ,, �.:; . . ; �: "��
<br /> 1 Xeu may apply for utility permits by nnail,or in person at:the,Ciry offices. ' .:. , �}:. .
<br /> , ''2..: 1Viailed in.applications are subjecti fo.th�p.ostage azad handling fee shown below: Permit cards ivill be seAt by �
<br /> , retum mail the same day the application is received. � . , � ,
<br /> ;. Pertnits are not valid until�ou receave a permit.card; . ` � � n� �
<br /> � 4. Work must n,at.begin unless the permit card is available,ozi the job site. `—�'`
<br /> • . 5.. Utility conunection pern�its may be,issued to license d coz�tractors on l y. � �
<br /> d. ' Contact t he Pu b lic Wor ks Dep a rt men t (9 5 2-2 4 9-4 6 0 0) f o r u t i Z i t y s t u b a s-b u i t t l o c a t i o n s. A O N O T .� \`
<br /> E X C a U A T E I N.ANY STREET AND DO NOT TAP A,�1Y MAIN without express approval of the Public %
<br /> � 'VVorks D�parbment. Tssuance of a pemut does not gxant this approval. + �.�
<br /> 7.� . All work xnust be done in accordance with State Code,requirements. . ��
<br /> : 8. All woxk must be xnspected before it is covered. Call.(952)249-4600.
<br /> ' � 24.hour notice required.
<br /> JOB SITE•ADDRESS: � � i/1 S � ��`�- '
<br /> Occupancy Type: Residential Co zA,excial
<br /> O�ner's Name: ^ .GtJ ' Phone IVumbe�: ��3 �.�� 3�a 7��
<br /> Mailina A.ddress: 3� � City: " �
<br /> Contractor's Name: � � Phone N ber: 7 � . � ����
<br /> _!c City: ►�� 7�pc �'3 7�
<br /> Mailinig.Address: O .
<br /> � PER, I1�!.IT TYPE , D
<br /> Municinal Sewver Connection($35.00 per stub) $ -'3-�' d
<br /> pipe size�inches; nc��terial. ✓Schedule 40 aiz tested; cast iron
<br /> SAC:Charge.(2000 rate$1,150,00)must accompany all sewer permi.t applications u.n.xess prepaid.
<br /> �If not p.repaid, a sewer corin.ection permit will not be issued.
<br /> � �' � D
<br /> - 1Vlunicipal Water Connection ($35.00 per stub) „ � �,3-��
<br /> � . , pipe.size_L iz�ches; matezxal�copper; otlaer
<br /> � WATER MExERS must be�icked up and pa'id for at City Hall:
<br /> - Water metexs .must be set and seaXed by Orono 'Water Depaxtment (952-249-4600) upon
<br /> ;, com�letion a�meter imstallation.
<br /> � . REQU'IRED minimum:setbacks from drain field and septic tanks =75'
<br /> .. REQUIRET�.setback from sewer liz�e=20'
<br /> �� EE _�ALCULATTON -. . . .. ,.. . .. . .
<br /> PERMIT F
<br /> � 1. _ Subtotal of above permit requested � - $ ���d v ' � '
<br /> Z. .: ,State Surcha� $ .50
<br /> : The State Building Code Division Surcharge of$.50 perpermit must be
<br /> . . included for each well,sewez and water connection permit requested. � ,
<br /> ` 3: Pos�a�e &�Iandling(Only rmax�-in applications) . $ ----�'S$�"'
<br /> . 4. . . �'OTAL, PERMTT FEE(add lines 1-3 above) $ �D ,S� _
<br /> The undersigr�ed hereby applies to the City of Orano for issuance of a Utilit�+'Permit, agrees to do
<br /> - all work in strict accordance with the ordiz�azi�ces of t}ie Cxty and the xegulations of the State o�
<br /> M�nnesota,and certifies tliat all state�nen,ts made on this application aze.complete,true and correct.
<br /> Signature o�Applicant; �!� : Date: D �a�l—O/
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