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.... .__ _ _ <br /> _ _ <br /> ,,__ =���c <br /> • CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> t Box 66 (1335 So Brown Rd) SEWER WATER <br /> Crystal Bay, MN 55323 <br /> *************************************************************************** <br /> 1. You ma�pp�or utility permi.ts by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fees shown below. . <br /> Permit cards will be sent by return mail the same day the application is received. <br /> 3. P�ennits are nat va]id imtil ynu reoeiv�e a pe.�it card. : <br />` 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connection p�xmits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Depart�ne.nt (473-7357) for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STRE�T AND DO NOT TAP ANY MAIN without express approval of the <br /> Public Works Department. Issuance of a pernut does not grant this approval. <br /> 7. All work must be done in accordance with State Code requireirients. � <br /> 8. All work must be inspected before it is covered. Call 473-7357. ,��� <br /> 24 haur notioe requirea. <br /> ***************************************************************�**********� <br /> , �-,�; , <br /> JOB SITB ADDRESS: o�G. � v� �— ��� - � - - <br /> Occupancy Type: Residential Commercial <br /> OWNER'S NAME: c.�.��� & �-�-� �a�""' P h o n e N o. : ��� - �� � 7 <br /> Mailing Address: 5' �� City: ���,-,�� <br /> � T����� <br /> CONTRACTOR'S NAME:��2ti�� Bus.�Phone: =��' � S(�� <br /> Mailing Address: City:(� i Zip: �;:5,�3� <br /> **************************** **** ******************* ******************** <br /> _ 3s c,t, PERMIT TYPE AND F� CALCIILATION <br /> MIINICIPAL SEWSR CONNECTION ( $3�6-�0 per stub) $ <br /> pipe size inches; material PVC (on sand fill} ; cast iron <br /> SAC Charge ( $700.00 ) must accompany alI sewer permit applications unless <br /> prepaid. If not prepaid, a sewer connection permit will not be issued. <br /> 3� o 0 <br /> MIINICIPAL WATER CONNECTION (�: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 = $133.00 ; 3/4" meters = $181.00; 1" meters = $235.00) <br /> Water meters must be set and sealed by Orono Water Department (473-7357) <br /> upon completion of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75 ' <br /> REQUIRED setback from sewer line = 20 ' <br /> ***********�*************************************************************** <br /> l. Subtotal of above permit requested $ <br /> 2. State Surcharge . 50 <br /> The State Bui lding Code Division Surcharge of .50 per permit must e <br /> included for each well, sewer and water connection permit requested. <br /> 3 . Postage � Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PSRMIT FEE (add Iines 1-3 above) $ <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, <br /> agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this <br /> application are co�lete, true and correct. � <br /> /� ., <br /> Signature of Applicant x a��� � Date: Z c� l `��1 C/ <br /> � I <br /> ; _ _ <br /> I - <br /> � <br />