HomeMy WebLinkAbout2002 - application for utility permits (Updated 5/3/02)
CITY OF ORONO APPLICATION FOR UTILITY PERMITS � J
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC l vU erm I f-
Crystal Bay, MN 55323 reCW reC9s"€..
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GENERAL INFORMATION ( eon
1. You may apply for utility permits by mail or in person at the City offices.
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
the application is received. C 1�H
3. Permits are not valid until you receive a permit card.
t eye,-not cotiNctrA,
4. Work must not begin unless the permit card is available on the job site.
5. Utility connection permits maybe issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND
DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a permit does not grant this approval.
7. All work must be done in accordance with State Code requirements.
8. All work must be inspectedec� ``
before
it is covered. Call
(952)249-4600,24 hour notice required.
JOB SITE ADDRESS: J 301.0
Occupancy Type: Residential Commercial
Owner's Name: Cl* ) apfzip Phone Number: `1(0'1- - 3g3
Mailing Address: 3650 A►"v .pto(tis City: . -iMOj--n Zip: 554-4---1
Contractor's Name:` 14t, 13 L 1ZS Phone Number: C=5t-cl --t 3cDo
Mailing Address: LI) pts N u.)‘1 f.3ANi City:Pew B Gt-ft Zip: ?—
PERMIT
PERMIT TYPE Zi Connections ❑Repairs Cl Disconnect (Check One)
SAC Charge (2002 rate $1,200.00) $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Connection/Disconnect/Repair ($35.00 per stub) $
pipe size inches; material Schd 40 air tested; cast iron
Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $
pipe size inches; material copper; other
WATER METERS must be picked up and paid for at City Hall.
Water meters must be set and sealed by Orono Water Department
(952-249-4600) upon completion of meter installation.
REQUIRED minimum setbacks from drain field and septic tanks=75'
REQUIRED setback from sewer line=20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surcharge $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per permit must be
included for each well,sewer and water connection permit requested.
3. Postage &Handling(Only mail-in applications) $ 1.50 (Mail In Only)
4. TOTAL PERMIT FEE (add lines 1-3 above) $
The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict
accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements
made on this appli ation are .mile -, tru; and correct.
� II
Signature of Applicant: t V Date: S'' 2 `0 r
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