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CITY OF ORONO APYLICATION FOR UTILITY PEItMITS <br /> Box 66 (2750 Kelley Parkway) , _ . SEWER/WATER <br /> Crystal Bay, MN 55323 <br /> GI;NLRAL 1NI'OI2MATION <br /> 1. 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 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 <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 SITE ADDRESS• ��'� ��-� -� _-1� <br /> Occupancy Type: v� " Resident�tI Commercial <br /> Owner's Name: ��J � '" � �_-•� PhoneNumber: =-��' - �, -- -=-� ���/ <br /> Mailing Address: '-��'S' �� City: 7�p: <br /> Contractor's Name: � �,:y� „ � - PhoneNumber: �y__,�� ,��� ��— <br /> Mailing Address:%� � �� City:��,���. 7�p: �;�� ��— <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ �'�'� �� ` _ <br /> �.��-; <br /> pipe size <-�' inches; materiak��,/� �pVC (on sand fill); cast iron <br /> SAC Charge ($850.00) must accompany all sewer permit applications unless prepaid. If not <br /> prepaid, a sewer connection permit will not be issued. <br /> Municipat Water Connectioii ($35.00 per stub) $ <br /> pipe size inches; material copper; odler <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 /> Separate Plumbing Permit issued for water meter. <br /> Water meters inust be set and sealed by Orono Water Department (473-7357) upon <br /> completion of ineter installation. <br /> R�QUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <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 perniit must be <br /> included for each well, sewer and water coimection permit requested. <br /> 3. Posta�e & Handling (Only mail-in applications) $ 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, agrees to <br /> do all work in strict accordance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> / . <br /> � <br /> � �.,lG� i-��� � Date: /i —i�- ,�� ;-- <br /> Signature of Applicant: �t�il�i <br />