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CITY OF OROVOBox 66 (1335 So Brown Rd) <br />Crystal Bay, HN 55323 <br />APFLICRTIOR FOR UTILin PERMITS SRIin NRTRR <br />n^^^^ylSr utility pezndts by nail or In peracm at the aty offices. <br />2. Mailed in applications are subject to the postage and handling fees shown below. <br />Pendt cards will be sent by return neil the ease day the application is received. <br />3. Bnite axe not selld wtU yon xeaslve a pendt cexa. <br />4. fioxfc mat not begin unless the pexxit card is available on the job site. <br />5. Utility connection permits nay be issued to licensed contractors only. <br />6. Contact the Public Mbrks Dqmrtment (473-7357) for utility stub as-built locations. <br />DO MOT BQCa^VJms m fW soar mo do not W any main without express approval of the <br />Public fioxfcs Department. Issuance of a permit does not grant this approval. <br />7. All work Bust be dene in acoardanoe with State Code reqidrenents* <br />8. All leirk mat be inspected before it is covered. Chll 473-7357. <br />24 hour notion raqiiixnd. <br />JOB BITS ADDRBSSt <br />Occupancy Typei <br />12U iD 1 ( P J <br />*8 HAMli <br />Residential ercial <br />Phone No.: <br />_ _ City: <br />Dus. Phone: <br />Mailing Address: <br />OOBTRBCTOR*8 MAMBi^^^^^ . ous <br />Mailing Address: I City: <br />PBRNZT nPB MD FBB CALCOLATIOI|, ^ <br />mnCIPAli SIMBR CO—CTIOB ($30.00 per s.tub) $_^_____________________ <br />pipe sise y inches: material PVC (on sand fill)icast iron <br />SAC Charge (^700.00) must accompany all sewer permit applications unless <br />prepaid. If not prepaid, a sewer connection permit will not be issued. <br />MOBICZPAL MATKS COCTBCTIOB ($30.00 per stub) $_ _ _ <br />pipe sise inches: material _ copper: other _ _ ______ <br />MATER METBSTmust be picked up anapaid for at City Hall. <br />(5/8* meters - $133.00} 3/4* meters - $181.00} 1* meters - $235.00) <br />Water meters must be set and seeled by Oroiio Water Department (473-73R7> <br />upon eempletioe of meter installatiom. <br />REQUIRED minimum setbacks from drainfield and septic tanks ■ 75* <br />REQUIRED setback from sewer line - 20* <br />4r- <br />1. Subtotal of above permit requested <br />2. State Surdiarge <br />The State Building Code Division Surcharge <br />Adi <br />.50 <br />of .50 per permit must be <br />included for each well, sewer and water connection permit requested. <br />1.50_ _ _ _ _3. Foetage a Bandling (Only mail-in applications) <br />4. TOTAL FEMIT FBB (add lines 1-3 above) $. <br />The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, <br />agrees to do all work in strict accordance with the ordinances of the City and the <br />regulations of the State of Minnesota, and certifies that all statements made on this <br />applicstion are ccsplete, tzw.and correct. <br />Signature of Applicant;(/^_^ ^ <br />■t <br />=¥ <br />in <br />Dat.i /Ih^ ‘i < <br />n-