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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (1335 So Brown Rd) SEVER MATER <br /> Crystal Bay, MN 55323 <br /> ou malt' <br /> apply for utility per by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fees shown below. <br /> Permit cards will be sent by 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. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the <br /> Public Works 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 rx)tice required. <br /> JOB SITE ADDRESS: <br /> Occupancy Type: Gam'' Residential Commercial <br /> OWNER' S NAME: \_. � C�w�" `m Phone No. <br /> Mailing Address : City: <br /> CONTRACTOR'S NAME: �� Q� �\3 Y 1 ��1 a��,y G� Bus . Phone: <br /> Mailing Address: M Q Q City: Zip: <br /> PERMIT TYPE AND FEE CALCULATION <br /> MUNICIPAL S R CONNECTION ( $30 . 00 per stub) $ 30 , 00 <br /> pipe size C` inches ; material PVC (on sand fill ) ; cast iron <br /> SAC Charge ( $700.00 ) must accompany all sewer permit applications unless <br /> prepaid . If not prepaid , a sewer connection permit will not be issued. <br /> MUNICIPAL WATER CONNECTION ( $30 . 00 per stub) $ <br /> pipe size k `, inches ; material copper; other <br /> WATER METERS must be picked up and paid for at City Hall. <br /> ( 5/8" meters = $133 . 00 ; 3/4" meters = $181 . 00 ; 1" meters = $235. 00 ) <br /> Water meters must be set and sealed by Orono Water Department (473-7357) <br /> upon completion of meter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75 ' <br /> REQUIRED setback from sewer line = 20 ' <br /> *************************************************************************** <br /> 1. Subtotal of above permit requested $ (� c <br /> 2 . State Surcharge . 50 <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 . Postage & Handling (Only mail-in applications) $ r 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, <br /> agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this <br /> application are complete, d correct. <br /> Signature of Applicanttrue an: t Date : <br /> ,4�S�, <br />