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t (Updated 6/2/03) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <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 are subject to the postage and handling fee shown below. Pernut cards will be sent by return mail the same day <br /> the application is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the pernut card is available on the job site. <br /> 5. Utility connecrion pernuts may be issued to licensed contractors only. <br /> 6. Contact the Public Works Depariment(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND <br /> DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a pernut does not gcant 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(952)249-4600,24 hour notice required. <br /> JOB SITE ADDRESS: J � l �4 r�� Lr.�rv� <br /> Occupancy Type: � Residential Commercial <br /> Owner's Name: F��� g:�, �,� S Phone Number: 7�/— 3�.3 7 <br /> Mailing Address: City: �.•��c������ Zip: S�� � <br /> Contractor's Name: (��,,.,D,S va�-,- � �� Phone Number: 7y( - �7 77 <br /> Mailing Address: y3leu �„ �p4 � �l,b . City: /h.�-.._�f,,;��, Zip: ,�1��f� <br /> '�1-���-w,a>4, ,�..,✓ J�/� Z <br /> PERMIT TYPE ❑Connections �epairs ❑Disconnect (Check One) <br /> � SAC Charge (2003 rate $1,275.00) $ (Set Rate) <br /> Sac Charge must accompany all sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Connection/Disconnect/Repair($35.00 per stub) $ <br /> pipe size �'�� inches; material ���Schd 40 air tested; cast iron <br /> Municipal Water Connection/Disconnect/Repair ($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 /> Water meters must be set and sealed by Orono Water Department <br /> (952-249-4600) upon completion of ineter installation. <br /> REQUIRED minimum setbacks from drain field and septic tanks=75' <br /> REQUIRED setback from sewer line=20' <br /> PERMIT FEE CALCULATION <br /> 1. Subtotal of above permit requested $ <br /> 2. State Surchar�e $ .50 (Minimum) <br /> T'he 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 &Handlin� (Only mail-in applications) $ 1.50 (Mail In Only) <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 all work in strict <br /> accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all staterrnents <br /> made on this application are com lete d rrect. <br /> ,��_ <br /> Signature of Applicant: Date: ��y o� <br />