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(Updated 6/2/03) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS " <br /> . . <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay,1VIN 55323 <br /> GENERAI.INFORMATION <br /> 1. You may apply for urility pemuts by mail or in person at the City offices. <br /> 2. Mailed in applicarions are subject to the postage and handling fee shown below. Permit cards will be sent by return mail the same day <br /> the applicarion is recei�-ed. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unlcss the pemut card is available on the job site. <br /> 5. Utility connecrion pemuU may be issued to licensed contractors only. <br /> 6. Contact the Public Works Deparnnent(952-249-4600)for utility stub as-built locarions. DO NOT EXCAVATE IN ANY STREET AND ' <br /> DO NOT TAP ANY M_�Lv`without express approval of the Public Works Department. 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 inspec:ed before it is covered. Call(952)249-4600,24 hoar notice required. <br /> JOB SITE ADDRESS: '`,�l'`� ��!��'��r ��•✓� <br /> Occupancy Type: �- Residential Commercial <br /> Owner's Name: S.L�� 6���� �— Phone Number: <br /> Mailing Address: �J6�— l'iG�=¢-s�.,�-j L�.�L City: Zip: <br /> Contractor's Name:w,c���- Cv'J�'T!/CJr✓tJ �, L�- Phone Number: <br /> Mailing Address: �ss��%y �c-�is �,s���/�r-� City: Zip: <br /> PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One) <br /> SAC Charge (2003 rate 51,275.00) $ (Set Rate) <br /> Sac Charge must accompan�-all sewer permit applications unless prepaid. <br /> (If not prepaid, a sewer connection will not be issued) <br /> Municipal Sewer Connecdon/Disconnect/Repair ($35.00 per stub) $ <br /> pipe size inches; material Schd 40 air tested; cast iron <br /> Municipal Water Co�nnection/Disconnect/R��e r ($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 `Vater 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 /> The State Building Code Division Surcharge of$.50 per permit must be <br /> included for each well,sea�er and water connection permit requested. � <br /> 3. Posta�e & Handling (Only mail-in applications) $ 1.50 (Mail In Only) <br /> 4. TOTAL PERNIIT 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 statements <br /> made on this application are complete, true and correct. <br /> � <br /> Signature of Applicant:� � ����-�r-,���-�� Date: f�' �— ����.3 <br /> �� , _ , , _ <br />