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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 /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications aze subject to the postage and handling fees shown below. Permit cards will be sent by <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 <br /> IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works <br /> Depariment. 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. Ca11473-7357. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: �8 b �X Fo2� Ro� <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: {��cJ K 5���-2l� Phone Number: �73— (",�J�/�' <br /> Mailing Address: 5'� On Fo� /�d City: d��,U t> 7ip: SS 3�3 <br /> Contractor's Name: C�e,� Y�cr�t�-�� Phone Number: �-/Y�--�,,70-Z <br /> MailingAddress: /�05`� w},,�ct=�,� �a,af City: �-�RNOv�+�. 7�p: 553�// <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub) $ ' <br /> pipe size�inches; material )C Schedule 40 air tested; cast iron <br /> SAC Charge ($1,000.00) 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 /> WATER METERS must be picked up and paid for at City Hall. <br /> (5/8" meters= $139.00; 3/4" meters =$191.00; 1" meters = $247.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department(473-735'n upon completion <br /> of ineter installation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks= 75' <br /> REQUIRED setback from sewer line =20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above pertnit requested $ ���c' <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. Postage & 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 do <br /> all work 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 /> �-- <br /> Signature of Applicant: Date: ' l "��'�� <br />