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'CITY ON' ORONO APPLICATION FOR UTILITY PERMITS ���� <br />Box tib (2750 Kelley Parkway) SEWER/WATER <br />Crystal Bay, MN 55323 <br />GENERAL INFORMATION <br />I. 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 fees shown below. Permit cards will be sent <br />by return mail the same day the application is received. <br />3. Penults are o,4 valid will you receive a permit cord. <br />4. Work must not begin unless the permit card is available on the job site. <br />5. Utility connection permits may be issued to licensed contractors only. <br />6. Contact the Public Works Gepariment (473-7357) for utility stub as -built locations. DO NOT EXCAVATE <br />IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works <br />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 inspected betorc it is covered. Call 473-7357. <br />24 hour notice required. <br />JOB SITE ADDRESS: <br />Occupancy Type: Resldtiltial Commercial <br />Owner's Name:. A/! � .d.., c . PImwNwnbcr: �/7_- -c 7 -j- I/ <br />Mailing Address: l _ City: ZJp <br />Contractor's Name:._j PbooeNurnbtr:d/.�IZ <br />Mailing Address: City: 1, <br />",c 2, S , <br />�RMIT TYpl: "T�— <br />Municipal Sewer Connection ($35.00 per stub) $ <br />pipe size t inches; material L PVC (on san•J till); cast iron <br />SAC Charge (581 .00) nwst accompany all sewer permit applications unless prepaid. If not <br />prepaid, a sewer connection permit will not be issued. <br />Municipal Water Connection ($35.00 per stub) 5 <br />r:oe size inches; material copper; other <br />WATER METERS trust be picked up and paid for at City Hall. <br />(5/8" meters = $133.00; 3/4" meters = $181.00; 1" meters = S235.00) <br />Separate Plumbing Permit issued for water meter. <br />Water meters must be sM and sealed by Orono Water Department (473-7357) upon <br />completion or meter installation. <br />REQUIRED minimum setbacks from drainfield 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 Surcharge $ .50 <br />The State Building Code Division Surcharge of S.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 <br />4. TOTAL PERMIT FEE (add lines 1-3 ah)ve) $ <br />The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to <br />do all work in strict accordance with the ordinances of the City and the regulations of the State <br />of Minnesota, and certifies that all statements made on this application are complete, true and <br />correct. <br />Signature of Applican�: < C' ,�. c _ Dime:z �`' ` <br />