Laserfiche WebLink
(iJpd ated 6/2/03) <br /> CITY OF ORONO APPLICATION FOR L-TILITY PERMITS - <br /> Box 66 (2750 Kelley Parkway) SEWER/�VATER& SAC <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <br /> 1. You may apply for urility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shon�n below. Permit cards will be sent by rehun mail the same day <br /> 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. Urility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for urility stub as-built locarions. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public W'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)249-4600,24 honr notice required. <br /> JOB SITE ADDRESS: 3�°I� ��10��1-, Sh o re. �r�"v� <br /> Occupancy Type: �� Residential Commercial <br /> Owner's Name: � �'�h � )�.��, Phone Number: <br /> Mailing Address: �SCu _ City: Zip: <br /> Contractor's Name: ' Q l--1� U'D ' Phone Number: �Sa- �-�a-�1'a..a� <br /> Mailing Address: City: ►'�p��y1p� Zip: �".S (n <br /> � <br /> PERMIT TYPE �.Connections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate $1,275.00) $ (Set Rate) <br /> Sac Charge must accompany all�sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Connection/Disconnect/Repair($35.00 per stub) $ <br /> pipe size�inches; material�� Schd 40 air tested: cast iron <br /> Municipal Water Connection/Disconnect/Repair($35.00 per stub) $ <br /> pipe size inches; material copper; other <br /> WATER METERS must be picked up and paid for at City Hall. <br /> Water meters must be set and sealed by Orono Water Department <br /> (952-249-4600) upon completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks= 75' <br /> REQUIIZED setback from sewer line=20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 (Minimum) <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. Posta�e &Handling (Only mail-in applications) $ 1.50 (Mail In Only) <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 all wark in strict <br /> accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements ':; <br /> made on this application are complete, true and correct. <br /> Signature of Applicant: Date: !� '� <br />