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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> , � Bog 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 until you receive a permit card. <br /> 4. Work must not begin unless the pernut 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 Departrnent(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 /> Department. 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. Ca11249-4600. <br /> 24 hour notice required. I. <br /> i <br /> JOB SITE ADDRESS: S � �� �1 I���2���� � <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: Phone Number: <br /> Mailing Address: City: 7ap• <br /> Contractor's Name: ��-2„a C, v� lvl—P�� Phone Number: �f"'�� —•U�— <br /> Mailing Address: �o,� �� City: h,t � 7�p: S'S-�� � <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 /> � <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' j <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 pernut requested. <br /> 3. Posta�e & Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERNIIT 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 statements made on this application are complete, true and correct. <br /> Signature of Applicant: Date: �''�9 ��_ <br /> � <br />