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Doc-04-2001 12:44pm From-CITY OF ORONO +9622484616 7-297 P.001/001 F-306 <br /> M t%Jpualpu 4uxlu1) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERNUTS <br /> Bog 66(2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay,MN 55323 <br /> GENERAL INFORMATION <br /> I. You may apply for utility permits by mail or b►person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will be sentby <br /> return mail the same day the application is rea;ived. <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 (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 /> Works Department. Issuance of a permit does not grant this approval. <br /> 7. All work must be done in accordance with Stage Code requirements. <br /> 8. All work must be inspected before it is coverei 1. Call(952)249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: L} \ �C✓ 1�rL��j <br /> Owner's Name; ctn,G�+ -�kc�/, x,, _ - Phone Number.Ut,;k--I.,iscl-tf ri <br /> Mailing Address:4 C�- City:_Cj\_-Cw C, _ zkx <br /> Contractor's Name: - Phone Number:. S!� - I <br /> Mailing Address _ City:l�"1 � <br /> PERMIT TYPE' <br /> Municipal Sewer Connection ($35.00 per stub) $ I <br /> Ver pipe size—i—inches; material, ,G�-Schedule 40 air tested; cast iron <br /> SAC Charge(2000 rate$1,150.00)must accoazpany all sewer peanut applications unless prepaid. <br /> V-�I A If not prepaid,a sewer connection permit will)wt be issued. <br /> Municipal Wateronnection($35.00 per stub) $ <br /> pipe size inches; material_ copper; a <br /> 44 _ <br /> WATER METERS mus eked up and paid for at City Hall. <br /> Water meters must be and sealed by Orono Water Department (952-2494600) upon <br /> completion of meter stallalion. <br /> REQUIRED minimum setbacks from drain Meld and septic tanks=75' <br /> REQUIRED setback$om sewer line=20' <br /> PFRM11 FEE.-CALCULATION <br /> t. Subtat lOfa1bomm+v mit.-&'_33 rd <br /> 2. State.Surclme $ .50 <br /> The Stain Building Code Division Surcharge oi'$.50 per permit must be <br /> included for each well,sewer and water connection permit requested. <br /> 3. Postage.&B ndiing(Only mail-in applications) $ 175.01 <br /> 4. TOTAL PERMIT FEE(add linos 1-3 above) $ �T) <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 /> C', <br /> Signature of Applicant: I )�i 01-'n- -e�tn Date: o-0 q <br />