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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box.66 (1335 So Brown Rd) SEWER WATER <br /> - Crystal Bay, MN 55323 <br /> **************************************************************************� <br /> . ou maj y�apply�tor 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. <br /> Permit cards will be sent by return mail the sam�e day the application is received. <br /> 3. P�nits are nat va.].id imtil yoni reoeive a �*'m;t card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility oonnection pex�uts may be issued to licensed contsactors only. <br /> 6. Contact the Public Works Department (473-7357) for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STRF�r AND DO NOT TAP ANY MAIN without express approval of the <br /> Public Works Department. Issuanoe of a permit does not grant this approval. <br /> 7. Al1 work must be done in accordance with State Code requirements. <br /> 8. Al1 work must be inspected before it is oovered. Call 473-7357. <br /> 24 haur mtiae required- <br /> *************************************************************************** <br /> � � ,,_ '� �- / �_ <br /> JOB SITE ADDRESS: l"��� ��'�"�� `��i���� G��`— <br /> Occupancy Type: Residential �_Commercial <br /> � ,�^��`� � �� � 5� <br /> OWNER'S NAME: �%-r�� '��'� Phone No. : � � ` � <br /> Mailing Address: City: <br /> �- • D <br /> CONTRACTOR'S NAN�:: ,�a�z- �r--���L_ ����ti'Y� Bus. P o�e: ��� �.��� <br /> Mailin g Address: c y�j s,a' City:� ,.��i�- Zip: ��<,�� <br /> *************************************************************************** <br /> P$RMIT TYPE AND FEE CALCULATION <br /> MIINICIPAL S� CONNECTION ( $30. O�r stub) $ <br /> pipe size Lt inches; material PVC (on sand fill) ; cast iron <br /> SAC Charge ( $700.00 ) must accompany all sewer permit applications unless <br /> prepaid . If not prepaid, a sewer connection permit will not be issued. <br /> MONICIPAL WATER CONNECTION ( $30. 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 campletion of ineter installation. <br /> REQUIRED minimum setbacks f rom drainfield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20 ' <br /> *************************************************************************** <br /> 1. Subtotal of above permit requested $ <br /> 2 . State Surcharge .50 <br /> The State Building 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 PERMIT FEE (add lines 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 anyl_correct. <br /> � <br /> Signature of Applicant� .-��'�� �����z�� Date: �C� ���� � �- <br /> v <br /> ��� 1 <br />