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. . � <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER <br /> Crystal Bay, MN 55323 <br /> GENERAL INFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City o�ces. <br /> 2. Mailed in applications are subject to the posta;e and handlin�fees shown below. Permit cards will be sent <br /> by retum mail the same day the application is received. <br /> ;. 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(249-4600)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 jrant 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 249-4600. <br /> 24 hour notice required. <br /> �5 -��� `�' ` <br /> JOB SITE ADDRESS: S <br /> Occupancy Type: ��Reside ti Commercial <br /> O�vner'sName• PhoneN�er• �7�' —��d� <br /> Mailing Address: City: ��.�.�r�,� Z�: <br /> Contractor'sName: PhoneNumber: ��i-�� /�.,/9'y-- <br /> Mailing Address: City: Zip: .��-�� S ` <br /> PERNIIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ �D�a-- ' <br /> pipe size�inches; material � Schedule 40 air tested; cast iron <br /> SAC Charge (2000 rate $1,100.00) must accompany all sewer permit applications unless prepaid. <br /> If not 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 /> WATER METERS must be picked up and paid for at City Hall. <br /> `Vater meters must be set and sealed by Orono Water Department(249-4600)upon completion <br /> of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks= 75' <br /> REQUIRED setback from sewer line=20' <br /> PERIVIIT FEE CALCULATION ov <br /> 1. Subtotal of above permit requested $ �� � <br /> 2. State Surchar�e $ .50 <br /> The State Buildin�Code Division Surchar�e of$.50 per permit must be <br /> included for each well,sewer and water connection permit requested. <br /> 3. Postaae & Handlin� (Only mail-in applications) $ � <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 do <br /> all �vork 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 /> Signature of Applicant: <br /> ' .z����� Date: �D "o��— �'i� <br />