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(Updated 5/3/02) <br /> CITY OF ORONO APPLICATION FOR UTILITY PERMITS � J <br /> Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC l vU erm I f- <br /> Crystal Bay, MN 55323 reCW reC9s"€.. <br /> . c <br /> GENERAL INFORMATION ( eon <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 application is received. C 1�H <br /> 3. Permits are not valid until you receive a permit card. <br /> t eye,-not cotiNctrA, <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connection permits maybe issued to licensed contractors only. <br /> 6. Contact the Public Works Department(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 permit does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. All work must be inspectedec� `` <br /> before <br /> it is covered. Call <br /> (952)249-4600,24 hour notice required. <br /> JOB SITE ADDRESS: J 301.0 <br /> Occupancy Type: Residential Commercial <br /> Owner's Name: Cl* ) apfzip Phone Number: `1(0'1- - 3g3 <br /> Mailing Address: 3650 A►"v .pto(tis City: . -iMOj--n Zip: 554-4---1 <br /> Contractor's Name:` 14t, 13 L 1ZS Phone Number: C=5t-cl --t 3cDo <br /> Mailing Address: LI) pts N u.)‘1 f.3ANi City:Pew B Gt-ft Zip: ?— <br /> PERMIT <br /> PERMIT TYPE Zi Connections ❑Repairs Cl Disconnect (Check One) <br /> SAC Charge (2002 rate $1,200.00) $ (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 meter 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 Surcharge $ .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. Postage &Handling(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 statements <br /> made on this appli ation are .mile -, tru; and correct. <br /> � II <br /> Signature of Applicant: t V Date: S'' 2 `0 r <br />