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<br /> �, �, C,T.TY QF ORONO APPLICATION FOR UTILITY PERMITS , w�
<br /> Box 6 6 (2 7 5 0 Ke l ley Par kway) S E W E R/W A T E R }��
<br /> Crystal Bay,MN 55323 �
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<br /> GENERAL INFORMATION �
<br /> 1. You may apply for utility permits by maii 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 permit card is available on the job site. " i ' ��
<br /> 5. Utility connection permits may be issued to licensed contractors only. -�>`
<br /> 6. Contact the Public Works Department(473-7357)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. �:'�
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<br /> 8. All work must be inspected before it is covered. Ca11473-7357. � ti
<br /> 24 hour notice required. ;' � , . " ;� � � `'
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<br /> JOB SITE ADDRESS: .�1� 5 /l�r �-��� �� '
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<br /> Occupancy Type: f Residential Commercial _
<br /> Owner's Name: GG/�,�r� PhoneNumber: ,���
<br /> Mailing Address: c City: 7�p: '
<br /> Contractor's Name: Phone Number: y,��a, - iy 9's—
<br /> Mailing Address: City: Zip: 5 s�_� � 5 --
<br /> PERMIT TYPE '�
<br /> Municipal Sewer Connection ($35.00 per stub) $ ���r�
<br /> pipe size 1� inches; material � Schedule 40 air tested; cast iron
<br /> SAC Charge($950.00)must accompany all sewer permit applications unless prepaid. If not prepaid, `',<-F�
<br /> a sewer connection permit will not be issued.
<br /> Municipal Water Connection ($35.00 per stub) $ � °i
<br /> pipe size inches; material copper; other
<br /> WATER METERS must be picked up and paid for at City Hall. '; `� ��
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<br /> . (5/8" meters= $139.00; 3/4" meters=$191.00; 1" meters = $247.00) `
<br /> Separate Plumbing Permit issued for water meter. � '
<br /> Water meters must be set and seaied by Orono Water Department(473-735'n upon completion
<br /> of ineter installation. � �
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<br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' • ,'t '� t
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<br /> REQUIRED setback from sewer line=20' " ;' ��
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<br /> PERMIT FEE CALCULATION
<br /> 1. Subtotal of above permit requested r ' - $ ' x
<br /> 2. State Surcharee $ .50 � �
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<br /> T'he State Building Code Division Surcharge of$.50 per permit must be _
<br /> included for each well,sewer and water connection permit requested.
<br /> 3. Posta�e & Handlin� (Only mail-in applications) $ 1.50 F=
<br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ ``<
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<br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do '>
<br /> all wark in strict accordance with the ordinances of the City and the regulations of the State of ' ��
<br /> �'-,? -, .
<br /> Minnesota, and certifies that all statements made on this application are complete,true and correct. � -�
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<br /> Signature of Applicant: ���� �����3�,o Date: /� ' � s�` _ �7 7 T F��
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