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CITX OF ORONO APPLICATiO�T�OR UTiLiTX�ERMITS �3�J_� <br /> Box 66 (275U RCcllcy I'arkway) SEWF..WWATClZ ccScc SAC <br /> Crystai B�y, MN 55323 <br /> . �og3N2 <br /> GENFRAI.INMU�LMATION (. � i�S-�� <br /> 1. You msy apply fo�u[iliry permits by mail or in person dt thc City o�ces. <br /> 2. Mailcd in applications arc tiuhjc;c:t tc>lhc postagc and h�ndling!cc shown bcl��w, ���rmil cards will bc scnt by rclum mail thc�am�duy <br /> thc application iti rcccivcd. <br /> 3. �'c��nnits are not valid u�til you receive a per�nmit card. <br /> 4. Wo�k rnust nut hegin unless thc pc:rmit card is avt�ilablc c>n thc,j�h�itc. <br /> 5. lJtiliry conncc;tion permits may bc issucd to liccnscd contractors only, <br /> 6. Con�tac�the Yublic Works Depatimcnt(952-249�600)forutilitystub as-built locations. DO NOT EXCAVAT��N ANY STRF,�T AND <br /> DO IVUT TAP ANX MAIN without cxpCcss apprnval of thc I�ublic Work,c pcparlmcnt. Issuancc of<<permit docs not grant this <br /> approvsl. <br /> 7. All wark nnust be done in accordance with S�xtc Code requiremcnt�. <br /> 8. All work must bc inti�ccted bc�'orc it is cnvcrcd. Call(952)249-4600,24-4A hour noticc requ�rcd. <br /> JOB SiTE Anp�ss: � o�e;r/ �i�a r�� <br /> Occupancy Ty�c: �tc�idcntial Commcrcial <br /> Owner's 1Vamc: i rhone Numbc�: �o/�- 3�/rJ • �%/�(� <br /> Maili�g,A,ddresa: �'� .a? /�b1T S City: 7.i�:._�'�� <br /> Cuntractor's Naicnc: n�;�„rT ��/,�,����i✓U /,,�c. p�unc Numhcr-,,l�o� _y,�,��7 <br /> Mailing Add�css: �i,�g p S � ��,n�v 93 , City•f�,�(L.�sc,� Zi�:_ �o� <br /> PF;�tMiT TYP� ❑Connc;clions ❑Rcpairs �iscon�nect (Chcck Une) <br /> SAC Char�;c (200.5 ratc$1,450.Q0) $ (SCt Ralc) <br /> Sac Ch�r�e�nnust accompa�y all scwc;r pe�xnit applicacioc�s unlcss prepaid. <br /> ([f not �rcpaad,a scwcr co�ncction wi�� �ot�c is,ucd) <br /> Mumicipal Sewer Connectio�/Aisconnect/Rcpair($35.00 p�r stub) $ - �'b � <br /> pipc siic in�hcs; malc:rial Schcl 4Q air tctilcc�; catil iron <br /> Munici�a�Water Con�ect�on/D;sco�nect/Re,�a��($35.00 pc�stut�) $ <br /> pipc siic;�� inck�cs; m�ticrial eopper; c�thcr <br /> WA'1'!;R MF,TERS must hc pickcd up and paid 1'or ut City I lall. <br /> Wvtcr meten mu�t be set und cculed by Orono Ws�ter Dcpur�ment(9S2-za9-4640) upon complctiun o1'metcr installation. <br /> R�QUIRL•'U minimum selbacks from drain tield and s�tic tanks—75' <br /> RF.QUIRGU tic.-tback�'rom scwcr l;nc � 20' <br /> PERM FEE A CULA .ON <br /> �. Subtotal �('abovc permit rcqucslcd $ 5� [�U <br /> Z. Statc Surchart►c $ .SU (Minirrxu�n) <br /> The State BuildiRg Codc Division Surcharge of 5.50 per pe�rmit mu�t be <br /> includ�d for c:uh wcll,u;wcr and walcr eqnn�*ction pc:rmit rc;yucstcd. <br /> >. Pc�tila*e& Handlin ► (Unly rnail-in applications) $ 1.54 (lV�ail Tn Unly) <br /> �. TOTAL PF,RMXT FF.R (add lincti 1-3 abovc) $ - ��,S� <br /> 11�c un.dersi�ncd hereby app�ies to the City of Ozono for issuancc of'a Utility Penmit, agrees to do all work in strict <br /> iccordancc with thc ordinanccs of lhc City and ih� rcgulaiions of th� Statc��Minncsc�ia, ancl ccrti�c:; that all tiiaicm�nts <br /> nadc on this application;:uc completc, tru� an corrcci. <br /> � � _ <br /> �ignaturc c>f'npplic:int: �' r)at�: — <br /> i 'd L696-B�Z-LOS '�u I °�u t zve.�zuo� zzo.��ed eBE �LO SO EO UeC <br />