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(IJpdated 5/3/02) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC <br /> Crystal Bay, MN 55323 <br /> � _ <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. Permit cards will be sent by return mail the same day <br /> the applicarion is received. <br /> 3. Permits are not valid until you receive a permit card. � <br /> 4. Work must not begin unless the pemut 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 Department(952-249-4600)for urility 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 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(952)249-4600,24 hour notice required. <br /> . � , � <br /> JOB SITE ADDRESS• �� � � ��� � � '�� ��� ��� � � �- ���, <br /> Occupancy Type:_ _��Residential Commercial <br /> r 1__ , <br /> Owner s Name: � ����c� F �i E c 1�- �C-Y��-���� u.� �-� � �. Phone Number: <br /> Mailing Address: City: I -���� Y r,�;�, I-�-- Zip: <br /> Contractor's Name: �� C. r�t d .` ,: ` - cati�,��;-��� !�;� Phone Number: -1L�� 5 �l`�i i 1`��� �{ <br /> Mailing Address:� �� 1-�C�� ,t 7-��� City:f� 1� �{" "�r � Zip: ����C 1 <br /> PERMIT TYPE ❑ Connections ❑Repairs �Disconnect (Check One) <br /> SAC Charge (2002 rate $1,200.00) , (Set Rate <br /> ) <br /> Sac Charge must accompany all sewer permit applications unless prep ' . <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 /> l. 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,sewer and water connection permit requested. <br /> 3. Postaae &Handlin� (Only mail-in applications) $ 1.50 (Mail In Only) <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ <br /> The undersi�ed 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: L.% ��-v1.- � ' Date: �-` �<: " �'�? <br /> -r--- <br /> �I <br />