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-�cp�� ����1�� � <br /> (Ur�ated 2/12/O1) <br /> CITY C�F ORONO APPLICATION FOR UTILITY PER�VIITS <br /> Bo��6 (2750 Kelley Parkway) SEWER/WATER <br /> , . <br /> Crystal Bay,MN 55323 <br /> E,� S 2001 <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. - � � ��.:���,: <br /> 2. I�iailed in applications are subject to the postage and handling fee shown below. Permit cards will be sent by <br /> retum mail the same day the application is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. «�ork 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 (952-249-4600) for utility stub as-built locations. DO NOT <br /> EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public <br /> ��'orks 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. Call(952)249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: �b�� /v��?_� � ft�✓'�' ��i u<�' <br /> Occupancy Type: t/� Residential Commercial <br /> Owner's\Tame: �������j;_,;�,� �iv G- �v�, Phone Number: �� ? ` ��� - 3�`6� <br /> Mailing Address: City: 7�p: <br /> Contractor's Name: r�(No�� Ro S Phone Number: 7c�5 � �2.F,`- ?.3`j3 <br /> Mailing Address: �,3 2.c1c: /c�G � /-1-c��,tJt City: �c,G.��S 7�:SS3� <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stu ) $ 3 s,�'�' <br /> pipe size�inches; material l�s�`Schedule 40 air tested; cast iron <br /> SAC Charge (2000 rate $1,150.00) must accompany all sewer permit applications unless prepaid. <br /> If not 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 VIETERS must be picked up and paid for at City Hall. <br /> Water meters must be set and sealed by Orono Water Department (952-249-4600) upon <br /> completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks = 75' <br /> REQUIRED setback from sewer line =20' <br /> � PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ 3 S: oU <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 & Handlin� (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 statements made on this application are complete,true and correct. <br /> Signature of Applicant: _��'�'v/= Date: `� �oc� ( <br />