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. CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 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 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 <br /> by return mail the same day the application is :eccived. <br /> 3. Permits are not valid until you receive a pera►it 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)forutility 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 /> JOB STTE ADDRESS: �� � � _`> �s',`-� � S�,��� �� ��� <br /> Occupancy Type: Residential Commercial <br /> Owner's Na.-ne: �,� '�'.y'L- C! '��_-� _�-�� ' Phone Number: <br /> Mailing Address: � J 7 s �J�='�S �"�--���' �✓� City: Zip: <br /> Contractor's Name: c�%2�Z G l✓�-�-%'���`--5���ti' Phone Number: <br /> Mailing Address'�� �7��/ -�Jl.�l�C �-_C. , City: � :,;� � c {�c ;� 7ip: <;,»'<;� <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ � � -� ) <br /> pipe size inches; material PVC (on sand fill); cast iron <br /> SAC Charge ($750.00) must accompany all sewer permit 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 /> �VATER METERS must be picked up and paid for at Ciry Hall. <br /> (5/8" meters = $133.00; 3/4" meters = $181.00; 1" meters = $235.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department (473-735'n upon <br /> completion of ineter installation. <br /> REQUIRED minimum setbacks from drainf'ield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <br /> k <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested � � � `�'-� <br /> 2. State Surchar�e $ .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. Posta�e & Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PE_RMIT FEE (add lines 1-3 above) $ _� 1� `� � <br /> ; <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to <br /> do all work in strict accordance with the ordinances of the Ciry and the regulations of the State <br /> of Minnesota, and certifies that all statements made on this application are complete, true and <br /> COITeCt. :9 y� j <br /> / / � <br /> �: `�. ,^� <br /> Signature of Applican� ' ` ���`� �� y� <br />