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� "' C1"1'Y OF ORONU APPLICATION FOIt UTILITY PEI2MI'TS <br /> Box 66 (2750 Kelley Parkway) SCWER/WATER <br /> Crystal 13ay, MN 55323 <br /> GCNCRAL INFORMATION ` � J � <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are suUject 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. <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. <br /> 8. All work must be inspected before it is covered. Call 473-7357. <br /> 24 hour notice required. <br /> JOBSITEADDI�SS: ��� � ������� � <br /> Occupancy Type: x R identi�l Commercial � <br /> Owner's Name: �.�,� �'/`'1jQ��u�� ���_ Phone Number: <br /> Mailing Address: ���City: 7�: <br /> Contractor's Name: �-l� ��"Phone Number: l� Z/— o j Z S <br /> Mailing Address: �/ 0 7 � City: `�-�� 7ap; .5.� �/ <br /> T� <br /> PERMIT TYP� <br /> Municipal Sewer Connection ($35.00 per stub) $ <br /> pipe size inches; material PVC (on sand fill); cast iron <br /> SAC Charge($850.00)must accompany all sewer permit applications unless prepaid. If not prepaid, <br /> a sewer connection permit will not be issued. <br /> Mu�iicip�l 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 �Iall. <br /> (5/8" meters = $139.00; 3/4" meters= $191.00; 1" meters = $247.U0) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters►nust be sct and sealed by Orono Water llepartment(473-7357)upon completion <br /> of ineter install.�tion. <br /> R�QUIRCD minimum setbacks from drainfield and seplic tanks = 75' <br /> REQUIRCD setback from sewer line=20' <br /> P�,ItMIT �EF, CALCULAT(ON <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 <br /> 7'I�e 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 & 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 Permit, agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Mim�esota, and certifies that all statements made on this application are complete, true and correct. <br /> Signature of Applicant: 1?ate:��/s� �(P ^ <br />