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�Dec �3 03 03: 05p James Martinson , 952 447-7674 p. 2 <br /> ', (Updatcd 6/2/U3) <br /> CYTY OF OR O APPLICAT ON FQR UTILITY PERMITS <br /> Box 66(Z 54 e ley Parkway) S WER/WATER& SAC <br /> Crystal B y, 55323 <br /> G�NERAL IN MAT[ON <br /> L. Yo may ply for uiility permits by mail cn in person at th City officcs. <br /> 2. Ma led i a plications are subject to the postagc and handli g fce sh9wn bciow. Pcrmit cdrds will be sent by rcturn rnail thc same day <br /> thc pli cm is received. <br /> 3. P its not valid until you reccive a permit card. <br /> 4. W mu t ot hcgin unlcss thc permil card is availablc on c job sit�e. <br /> S. Uti 'ty Ction permits may be icsued ta Licenscd contrac ors only. <br /> 6. Co Mct Ublic Works Department(952-Z49-4600)for uti ity stub as-built lacations. DU NOT TJCCAVATE TN ANY STRF.ET AND <br /> D NQT �'ANY MAIN wi�houl express approval of the ublic Works Dcpartmen�. Issuance of a permil docs not prant this appmval. <br /> 7. AU ork � 9t be done in accordance wilh Stale Code requi ments. <br /> R. All ork �t be inspecled before il is covered. Call(952) 49-4600,24 hour notice rcquind. <br /> JOB SIT AD ESS: �� -S '�� pr�� � 1�E-i • <br /> Occupan T Residential, Commercial <br /> Owner's am •> � � Phone Nurober: �iS� �/�/7•- 76 7 c�/ <br /> Mailing � d.dr �S S� �!'L�/AL��b''r�w: j����vo City:�'.��,;.^ L�.k,: ZiQ: � S3 �:,� <br /> Coatract r's a• e: N�t r T:r��,n i�:,�L/ r- S�.n�,� Pbone Number: �S,�- 7 S 6 -=f 9'�,,� <br /> Mailing ddr City: Zip: <br /> PE ❑Conncctions ❑Repairs isconnect (Check One) <br /> SAC Cha e 03 rate$1,275.00) , $ (Set Rate) <br /> 5ac Charg mu t a.ccompany all sewer permit application unlesslprepaid. <br /> (If not pr pai sewer connectian wil! not be issued) <br /> Municiga S Connection iscon eps�ir($35. 0 per stub) $ 35.� <br /> pi siz inches;ma erial Schd 40 ai testedi cast iron <br /> Municipa Ws e Connectio isconn�IRepair($35. 0 per�tub) $ 3J.DD <br /> pi siz inches;material copper; othcr <br /> WATER T S must be picked up and pAid for at Ci HaU. <br /> Water m ers t be aet and sealed by Oruno Water epartment <br /> (952-249 600 pon completion of ineter installation. <br /> QUIRED minimum setbacks from drai ficld and septic tanks= 7�' <br /> QUIRED setback fram sewer line=20' <br /> PERMI E ALCULATION <br /> 1. Su ota f above permit requested $ <br /> 2. tc S har c $ .50 (Minimurn) <br /> TG Stat B Ilding Code Division Surcharge of 5.50 per p 'i must be <br /> ipc ud�d each well,scwcr and walcr conncction pccmit quested. <br /> 3. Po a dlin (Only mail-in applications) $ 1.50 (Mail 1n Only) <br /> 4. T TA �RMIT FEE (add lincs 1-3 abovc) $ <br /> The unde 'gn hcrcby applics to thc City of Orono fo issuaqcc of a Utility Pcrmit, agrccs to do all work in strict <br /> accordane wit he ordinances of the City and thc regula ons of thc State of Minnesota,and certifies that�11 statements <br /> made on t is a icarion are c plete,true and correct. <br /> Signature f A p icant: v� �.r� Date: �� '�� 3 �� �' -3 <br />