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; � CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> � Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 <br /> � <br /> � GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> � 2. Mailed in applications are subject to the postage and handling fees shown below. Permit cards will be sent by <br /> ` return mail the same day the application is received. <br /> � 3. Permits are not valid untit you receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <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 <br /> � <br /> IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works <br /> � Deparhnent. Issuance of a permit does not grant this approval. <br /> � 7. All work must be done in accordance with State Code requirements. <br /> � 8. All work must be inspected before it is covered. Ca11473-7357. <br /> '{ 24 hour notice required. <br /> ` <br /> r JOB SITE ADDRESS: /�/� S� �v,� u ��.� �c �l v" � <br /> Occupancy Type: � Residential ' Commercial <br /> Owner's Name: �U n t- �.��/ Phone Number: �3 ' 7/ 3 Sr <br /> Mailing Address: s�i,n-c. City: ���-.� o Zip: SS" 3 5� � <br /> Contractor's Name: S�ll���� �-, v 1-� I� I--rt S�; Phone Number: �(7 3 -y 36c7 <br /> Mailing Address: 34��Q S� /_/w y /�t City: t,.�_���-�,7ip: � S'3 S� <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $�; 2 L�O _ <br /> � pipe size inches; material Schedule 40 air tested; cast iron <br /> SAC Charge($950.00)must accompany all sewer permit applications unless prepaid. If not prepaid, <br /> � a sewer connection permit will not be issued. <br /> � Municipal Water Connection ($35.00 per stub) $ <br /> j pipe size inches; material copper; other <br /> � WATER METERS must be picked up and paid for at City Hall. <br /> � (5/8" meters= $139.00; 3/4" meters= $191.00; 1" meters = $247.00) <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 <br /> �; of ineter installation. <br /> + <br /> REQUIRED minimum setbacks from drainfield and septic tanks= 75' <br /> ' REQUIRED setback from sewer line=20' <br /> � <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. <br /> '{ 3. Postage & Handlin� (Only mail-in applications) $ 1.50 <br /> � 4. TOTAL PERMIT FEE (add lines 1-3 above) $ <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Pernut, agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations of the State of <br /> � Minnesota, and certifies that all statements made on this application are complete, true and correct. <br /> � <br /> Signature of Applicant: ' Date: I Z- � ll ' �� <br />