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CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> , , �og 66 (2750 Kelley Parkway) SEWERIWATER <br /> Crystal Bay, MN 55323 � <br /> GENERAL INFORMATION �f / ��� <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 pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Departrnent(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 /> Departrnent. Issuance of a pernut 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 249-4600. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: �� � � - �� � � -r <br /> Occupancy Type: Residenti Commercial <br /> Owner's Name: «�� �,�.s-r' �rY..� Phone Number: <br /> Mailing Address: City: 7�p: <br /> Contractor's Name: � � Phone Number: � ��'z� <br /> Mailing Address: �� �6' `1 S� � s� ����c� (� ,F-- City: � p (,l n� �p: �� S`S3 �� <br /> PERMIT TYPE <br /> Municipal Sewer Connection ($35.00 per stub� $ <br /> pipe size � inches; material Schedule 40 air tested; cast iron <br /> SAC Charge ($1,050.00) must accompany all sewer pernut 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 = $130.00; 3/4" meters= $180.00; 1" meters= $240.00) <br /> Separate Plumbing Permit issued for water meter. <br /> Water meters must be set and sealed by Orono Water Department(249-4600) upon completion <br /> of ineter installation. <br /> REQUIltED 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 /> � � �--� <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. Posta�e&Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERNIIT FEE (add lines 1-3 above) $��, S � <br /> The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do <br /> all work in strict accordan e 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 /> Signature of Applican . � Date: �'- �� CL C� <br />