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CITY OF ORONO APPLICATION FOR UTII.ITY PERMITS ' <br /> � Boa 66 (2750 Kelley Parkway) SEWER/WATER , <br /> '� Crystal Bay,MN 55323 , <br /> � <br /> GENERAL INFORMATION � <br /> L You may apply for utiliry 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 /> retum mail the same day the application is received. � i <br /> 3. Permits are not valid until you receive a permit card. , <br /> 4. ;:;,1 Work 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. 'y�' � Contact the Public Works Department(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 Pub.lic Works <br /> Departmen� 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 249-4600. <br /> 24 hour notice required. <br /> €� 32-� 2 <br /> JOB SITE ADDRESS: �iG� �o.cf� ���---��?i� <br /> Occupancy Type: �Residential Commercial <br /> Owner's Name: .Q�,Q ce�.��- Phone Number <br /> Mailing Address: City: tip: <br /> Contractor's Name: �.����-�- PhoneNumber: 5�5'G ys�s's-' <br /> Mailing Address: �a d x o2/9 City:�S%.C�.�.r�i,�,� 7ap: �5.3�'— <br /> PERNIIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ <br /> pipe size_�inches; material chedule 40 air tested; cast iron <br /> SAC Charge ($1,050.00) must accompany all sewer pernut applications unless prepaid. If not <br /> � 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 METERS must be picked up and paid for at City Ha1L <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' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ � <br /> 2. ' State Surcharee $ .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. Postage&Handling(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 Pernut, agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Muinesota, and certifies that all statements made on this application are complete, true and correct. <br /> Signature of Applicant:/o� v , Date: s'�"'�9 <br />