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<br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS ' � > � '�
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<br /> ,.Box 66 (2750 Kelley Parkway) SEWER/WATER ��i�� a r' � �
<br /> " Crystal Bay, MN 55323 �
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<br /> s_;; GENERAL INFORMATION " t �
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<br /> '< 1. You may apply for utility permits by mail or in person at the City offices. '`'�
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<br /> 2. Mailed in applications are subject to the postage and handling fees shown below. Permit cazds will be sent by z-
<br /> return mail the same day the application is received. '~`
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<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. - 4`i� '�
<br /> 5. Utility connection permits may be issued to licensed contractors only. ""�
<br /> 6. Contact the Public Works Department(473-7357)for utility stub as-built locations. DO NOT EXCAVATE �y`
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<br /> �� IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works . ° , l,��
<br /> Department. Issuance of a permit does not grant this approval. � �
<br /> 7. All work must be done in accordance with State Code requirements. t °�:r
<br /> 8. All work must be inspected before it is covered. Ca11473-7357. ° � ` , . N �r
<br /> 24 hour notice required. � � � ' *` �� �` � �` �' a � ..� '� �`�
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<br /> � � � � JOBSITEADDRESS• �9°a�Y��-� `�--�-�� �``� =��
<br /> Occupancy Type: x Residential Commercial �A
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<br /> Owner's Name: ,falc�C� ��� 9��'� ��-� =' Phone Number: ; �, �
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<br /> Mailing Address: � q� y-,�, � Q��— City: /�%_� "� ��� 7ip: �', ' ;
<br /> Contractor's Name: ��',�zC.c_e-ti=� �-�-f�-�t--�—��*-�_� PhoneNumber: �,� �r'-Y��� �' t � }
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<br /> Mailing Address: �F'��� �-����� f�z� City:r.����-��'--z_�.��_ 7�; sS;�� i = " �;
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<br /> PERMIT TYPE �� �� . i.-
<br /> Municipal Sewer Connection ($35.00 per stub) $ � ` �
<br /> pipe size � '� inches; material `� PVC (on sand fill); cast iron .�� � ��
<br />� SAC Charge($900.00)must accompany all sewer permit applications unless prepaid. If not prepaid, r '�,
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<br />�7' a sewer connection permit will not be issued. : �
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<br /> Municipal Water Connection ($35.00 per stub) $ , ���'°
<br /> �: pipe size inches; material copper; other ��; � , ;
<br /> � WATER METERS must be picked up and paid for at City Hall. <�
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<br /> � (5/8" meters= $139.00; 3/4" meters= $191.00; 1" meters= $247.00) ` � �'
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<br /> Separate Plumbing Permit issued for water meter. '�'� �
<br /> Water meters must be set and sealed by Orono Water Department(473-735'n upon completion '� ,�
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<br /> 4 ` �'` of ineter installation. $
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<br /> REQUIRED minimum setbacks from drainfield and septic tanks=75' ' ��.'
<br />� � REQUIRED setback from sewer line=20' ` `'
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<br />� PERMIT FEE CALCULATION ���' ` ��
<br /> 1. Subtotal of above permit requested $ �
<br /> 2. State Surchar�e $ .50 �
<br /> The State Building Code Division Surcharge of$.50 per permit must be <
<br /> included for each well, sewer and water connection permit requested. ` � c �'
<br /> 4 3. Postage & Handline (Only mail-in applications) $ 1.50 ` � �}>
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<br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ �: r r �
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<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 � tiF ` '�
<br />��,_ Minnesota, and certifies that all statements made on this application are complete,true and correct. �;
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<br /> Signature of Applicant: ���'�r�� -�� Date: , �/- y� ;�`
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