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FROM : PHONE N0. : 612 477 6208 Oct. 02 2001 08:26AM P1 <br /> . -"'' ' ,. �, (l,J►;sJwted 2/121U1) <br /> ;....,. <br /> ,.. , <br /> , . <br /> , 4 - <br /> C�TY.OFO�,tOlr10` . 1 . ;APP.�Y:�A1T��T;FUI,tUT�LIT`S�PERM�TS <br /> -,;.: . <br /> µ . . . �. :. . � � '�. :�:...:,.'.� . ... :.•.. . :.• .:.�, � , � <br /> . . �'.°].i.,C.'.,,�'..:'�:;'.:,.::.. . <br /> . Svx 66 275U Kelle parkway� , �. ,. SEA�R/WATER: <br /> ( Y <br /> Crysta�Bay, MN 53323 ��� •�z , n- � .�_ -:� � � ; <br /> Jc� �`� ���� <br /> c:ENERAY.IIVFORM;�A�.'�1� �- � � ' ��- <br /> --����. <br /> 1, You may�apply for utifity permits by mail or.io person t the Ciry o��tc�s. <br /> 2. M�iled in applications axe subJect to the pvst�ge and handling.fee shown below.. Permit cards wil!be sent by <br /> return.mail the.same day the application is received. . <br /> 3. Permits are not valid until yau receive a permit card. � � <br /> � 4,, Work tnust aoc begin unloss the perir�it card is a�vai]�ble on tbe ja6 site. <br /> . S. Utiliry coruiec�ion perm�ts may be{ssued to licensed contractors only. <br /> d. Contact the Public Works Department (952-249-4600) for utility stub as built locations. DO NOT <br /> �XCAVATE IN AN'Y.5TREET AND DO NOT TAP ANX�MATN vvithout express approval o�the Poblic <br /> � Wocks Departrxte�t, Issuance of a pe�mit does not grant this epproval. � <br /> 7, Ail worlc must be done in accordance weth State Code requirements. � _ <br /> 8. All work must be inspected bcsPore it is cover.ed. Call(952)249-�160U. �'i �'"r�> <br /> � Z4 hour not9ce regufred. �C'� F <br /> � <br /> JOB�SYTE ADDRFSS: �� 3 1 �-�� �������5 �u r - <br /> Ocaupaacy Type: Residential Commercial <br /> Q�wner's.Name: psf Phone Number:�I�v3) ,���''o`�7��' <br /> MaiCine Addreas: 33 � City: f��� �5 Tpc ���5� 7� <br /> Contractor's Name: � e Phone um � �v-3 — -� <br /> Mailing Address: f�0 �itS': 1 �� �s� 7� <br /> � PERMM� �'�'YPE , � �� <br /> �Nivarcipal Sewer C nnection (�35.00 per stub} � , � jJ � -r <br /> pige si2c�inahes; material . �chedule 40 air tested; cast iron <br /> �SAC Chazge (2000 rate $1,154,00)must accompany all sewer permit applications unless prepaid. <br /> . . If not gr.ep..aid, a sewer connection permit will not be issued. <br /> Municipal W�ter Counection($35.00 per stub) $ ����' � � <br /> pipe size / inches; material t�opper; other <br /> . �ATER NiETERS must.be picked up and paid for at City Hall. <br /> � Water meters must be set and :ealed by Orono Water Depaa-timent (952-249-4600) upon <br /> compYetioa of ineter installatioa. <br /> REQUIRED minimum setbacks frot�drain field ax�d s�p�ic tanks=75' <br /> REQUIRED setback from sewer line=20' <br /> pE,BJ�V IT � CALCULAT�N <br /> . . , ...: <br /> 1. Subtotal of above permit requested ' � � $ �0�� � <br /> 2, State S��r�e_ � $ .50 <br /> The State Building Code Division Surcharge of$.50 per permit mdst be <br /> inciuded for each well,sswer and water connection pern�it requested. <br /> 3,, 'Posta�e &Haradli,� (Only mail-in applications) $ --�'�� <br /> : �� , �a�.:'� TOTAL PEYtN1IT FEE(add liz�es 1-3 al�ove) . $ O • � <br /> The undersigned hereby appli�s to the City of Orono for issuanc�of a�Jtility Perm�t, agrees to do <br /> al� work in strict accordance with the ordinances o�the City and the regulations of the Stat� of <br /> Minnesota,and eertifies that all statements made on this�application,aze complete,true and correct. <br /> � , . � <br /> Signature of Applic Dat�e: � l <br />