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FROM : PHONE N0. : 612 477 6208 Oct. 02 2001 08:28AM P3
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<br /> CITY�OF ORONO �.PP,LICATXUN FOR�,LTTILYTY PERMTTS. .
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<br /> . :.: .: ••Box`.66.(2750 Ke11ey:Pfur�cway)°.:::..:''�.:. ^`:;:::�'; - '� ���' E;� . .
<br /> `S' f R/VVATER'`:
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<br /> . ... . ....:.. ry,sta[Bay.��: 55323 �,::: :'
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<br /> G'EN RAY.' FORM T,► I�ON :, .'.:': : ;' - ', .
<br /> ; 1,. : ; You inaY aPP1y for uti�iity permits by zzi,ail,or in.persvn-aC�the.City:offices., . . ;. :
<br /> � :.2,:, l�iail�d in a�iplications are subject to ttie.,postage:and�:andliiig fee shown below. �'ermit cards will be sent by
<br /> . X6iUrn m�ill.Uic aaiuv Say tlic application ia rceeivod,
<br /> 3. ; �ermits are not valid until yo'u ireceive a permit card. ' •
<br /> � 4,., . , Work rraust not begin uriless the permit card is available on tb�e job site. .
<br /> S, Uciliry conn�ction permits may be issued to lieensed con�actors o.nly. �
<br /> 6, Contact the Pubiic Works Depaa�timent (952-249-4600) for utility stub as-built lpeations. DO NOT
<br /> �XCAVAT�IN ANY Sx�tEET AND DO NO'�TAP`AI�'Y MAIN without exp�ess approval of the Public
<br /> WoXks Department. Issuancc of a permit does not gTant tl�is approval.
<br /> 7. . . Alk work must be doae in accordance with State Code requirements.
<br /> 8�. AlI work must be inspected.before it is covered. Call(952)249-4600. � ��i uvV (\� .
<br /> � Z4 hour notice required. ��7 ���
<br /> �OB.S�'I'E ADDRESS: � � 3? L If ��i�'l�i ��da� �D�.�r`7'
<br /> Occupancy Type: Residential Curumercial
<br /> Owner's Name: �e �s fi' GS � Phone Number:�/1o.3) ,�S 3�'o�7�-�'
<br /> 1VYaili�ng Address: o �3 � City: /j� /5 `7�i; �Sf� 7�
<br /> Contractor's Name: � e phon�e umber �v� ����
<br /> 1V�ailing Address: ODD 1� . City: 7_iq�: �'S3 73
<br /> 'PER.MIT T'S.'PE �,� —�-�
<br /> � Munieipal Sewer C .nn�eetion ($35.00 per stub) $
<br /> � , pipe size�inches; m�terial �ched�l�40 aar tested; cast iron
<br /> SAC Charge (2000 rate $1,150.00) rx�ust accompany all se�►er pez�it applications wri�ess prepaid.
<br /> . , If not.prepaid, a se�ver connection permit will z�ot be issued.
<br /> Mu�aicipal.Water Connection ($3�.00 per stub) $ 3-S, O a
<br /> pi.pe size / inches; mnterial �/opper; ot her
<br /> WATER METEY2S must be picked up and paid;for at City Hall_
<br /> Water meters must be set and sealed �y Orono Water Depari�ment (952-249-4600) upon
<br /> completion of ineter insta[lation:.
<br /> REQUIRED m�nimiun setbacks from drain fie�d and septic tanks =75'
<br /> REQUIRED setback from sewer line=20'
<br /> PE IT FFE CAY.CULATION . . � .. � �
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<br /> 1.. Sixbtotal of above permit requested � � d�Q D
<br /> 2.. State.Surchar e $ .50
<br /> Tkie Sta[e Building Code Division 5urcharge of$.50�er,permit must be
<br /> included fo�'each well,.sewer and water connection perr�it requested:
<br /> 3; , pvsta�e & Handlin� (Only zx�ail-in applxcations) $ •,
<br /> . 4. .TOTAI:PERMIT FEE(add lines 1-3 above) $ .�0 r��
<br /> The undersign,ed hereby appl�es io tt�e i.:iry of vrono for is5uttucc uf a U�il��y I'cruiit, ag�oc�to de
<br /> all work in s�-iet accordanee with the oTdinances of the City and the regulations. of the State of
<br /> Minnesota, and certifies that a11 statements made on this app�ication aze eomplete,true and cortect.
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<br /> Si�nature o�Applica : Date:
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