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CITY OF ORONO APPLICATION FOR UTILI'Tx PER1dIITS <br /> Boz 66 (2750 Kelley Parkway) SEWER/WATER � <br /> ' Crystal Bay, MN 55323 <br /> . � �1�' � �� <br /> GENERAL INFORMATION dt, 7�. <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 1" J <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 until 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(249-4600) for utility stub as-built locations. DO NOT EXCAVATE <br /> IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works <br /> Departrnent. Issuance of a pemut 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. Ca11249-4600. . <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: I��� LG� �, L�i GC c Q ���, <br /> Occupancy Type: _�Residential Commercial <br /> Owner's Name: %a�i Cu s Gi v��c Phone Number: <br /> Mailing Address: 1 SO�' L-�v,� L-�k� � /v�P� City: �v�o�� 7ap: S�-3 S'6 <br /> Contractor's Name: ��, //toa,�'s U�t/'�-i 5-�-���� PhoneNumber: �/73-y3oo <br /> Mailing Address: 3 G�o���,Gr�ISo, � City:Cl� Z 7ap:S'-,�`�9� <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ <br /> pipe size inches; material Schedule 40 air tested; cast iron <br /> SAC Charge ($1,050.00) must accompany all sewer permit applications unless prepaid. If not <br /> prepaid, a sewer connection permit will not be issued. <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. <br /> (5/8" meters= $130.00; 3/4" meters = $180.00; 1" meters= $240.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department(249-4600) upon completion <br /> of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks= 75' <br /> REQUIRED setback from sewer line= 20' <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 & Handling (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 Permit, 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 state ents made on this application are complete, true and correct. <br /> SignatureofApplicant: Date: G'�����% g <br />