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► " C1TY OF ORONO Al'PLICATION FOR UTILITY PEI2MITS <br /> Box G6 (2750 Kelley Parkway) SEWER/WAT�R � <br /> Crystal B�y, MN 55323 �j f ; <br /> �GNCRAL INFORMATION <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 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 oniy. <br /> 6. Contact the Public Works Department(473-7357)for utility stub as-built locations. DO NO'I'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 /> JOBSITEADDRESS: �� �� � <br /> Occupancy Type: Residen ial Commercial <br /> Owner's Name: Phone Number: <br /> Mailing Address: C��,: �, <br /> Contractor's Name: Phone N mber: —� QS� <br /> Mailing Address: �0 City: 7�p; <br /> PERM IT TYP� <br /> Municipal Sewer nection ($35.00 per stub) $ <br /> pipe size� inches; material PVC (on sand fill); cast iron <br /> � <br /> SAC Charge($850.60)must accompany all sewer permit applications unless prepaid. If not prepaid, <br /> a sewer connection permit will not be issued. <br /> Municip�l Watcr Connection ($35.00 per stub) $ <br /> pipe size inches; material copper; other <br /> WATER ME"I'�RS 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 /> W�ter meters must be set and sealed by Orono Water Department(473-7357)upon comptetion <br /> of ineter inst:�llation. <br /> REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br /> REQUIRED setback from sewer line = 20' <br /> P�ItMIT FCI: CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surcharge $ .50 <br /> The State [3uilding Code Division Surcharge of$.50 per permit must be <br /> included for eacl�welf,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 tha 11 statements made on this application are complete, true and correct. <br /> ` ���� <br /> Signature of Applicant: Date: <br />