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<br /> t:,�ITY OF ORONO APPLICATION FOR UTILITY PERMITS �`'��
<br /> ' Box 66 (2750 Kelley Pazkway) SEWERIWATER ��(t's � ' �
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<br /> Crystal Bay, MN 55323 ' , ,,:
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<br /> GENERAL INFORMATION � � �� �`� � � �,'',��:��
<br /> 1. You may apply for utility permits by mail or in person at the City offices. ��. �x
<br /> 2. Mailed in applications are subject to the postage and handling fees shown below. Permit cards will be sent by �`;;: , ,iQ
<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 � ��"
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<br /> IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works !f �;
<br /> Department. Issuance of a permit does not grant this approval. ��
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<br /> 7. All work must be done in accordance with State Code requirements. . ,�,_,
<br /> 8. All work must be inspected before it is covered. Ca11473-7357. u�~:;� ��,���� ����
<br /> 24 hour notice required. � , �,'°�_� ,� _ �' ,�`
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<br /> JOB SITE ADDRESS: � �� � M'
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<br /> Occupancy Type: Resid tial Commercial y
<br /> CQ T- t� Phone Number: L�7� ,��g� '�` �
<br /> Owner's Name: �
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<br /> Mailing Address: rrr- 0' City: ��v�.� 7�: ,�;��(o �'_�;�
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<br /> Contractor's Name: _`t PhoneNumber: T7� l�'( � �, .�
<br /> Mailing Address: /1 q��i ,�w��'�S' City: ,Lor� iG�a 7�p: 5�3;; '�. �
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<br /> PERMIT TYPE '� ' �
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<br /> Municipal Sewer Connection ($35.00 per stub) $ •_ }�.�
<br /> pipe size inches; material Schedule 40 air tested; cast iron �; } �
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<br /> SAC Charge($950. 0)must accompany all sewer permit applications unless prepaid. If not prepaid, : ��
<br /> a sewer connection permit will not be issued. =�, �`�
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<br /> Municipal Water Connection ($35.00 per stub) $ �:� �" �k
<br /> pipe size inches; material copper; other <' � �
<br /> WATER METERS must be picked up and paid for at City Hall. �� " �
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<br /> (5/8" meters = $139.00; 3/4" meters = $191.00; 1" meters= $247.00) � "' � �'
<br /> - Separate Plumbing Permit issued for water meter. F �� �
<br /> Water meters must be set and sealed by Orono Water Department(473-735'�upon completion �� ��
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<br /> of ineter installation. = ��a
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<br /> REQUIRED minimum setbacks from drainfield and septic tanks=75' � `�� ��
<br /> REQUIRED setback from sewer line = 20' x �' � � _ � � ' ��
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<br /> PERMIT FEE CALCULATION ` � S�
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<br /> 1. Subtotal of above permit requested $ 3 � �'
<br /> 2. State Surchar�e $ .50 �' 'k '� �i
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<br /> The State Building Code Division Surcharge of$.50 per permit must be r � 'Y
<br /> included for each well,sewer and water connection permit requested. ' � k
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<br /> 3. Postage & Handling(Only mail-in applications) $ 1.50 �} ,y ,' �
<br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ `' �` �?
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<br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do ' `x:
<br />�`' all wark in strict accordance with the ordinances of the City and the regulations of the State of � �
<br /> t Minnesota, and certifies that all statements made on this application are complete, true and correct. '�
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<br />' Signature of Applicant: � _i�t.�- �i���;�� Date: ��� :
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