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\ Al l VI Vf�VI\V � VILYI ,JVJIV V//L// /I IJ.�/ LJ' .VL/VL i\V.VJV <br /> � , l:l`['Y Uh'Ukt3NU APPLICATION F()R t71'ILITY I'ERNiITS <br /> Box 6b (275Q Kellcy Pr,trkw�y) SEWEI�ilWATER <br /> Crystal Bay� MN SS3f3 <br /> GE;L��,A,l,[N�'OftMAT[ON <br /> 3. You rs�ay apply for utility pormits by mai]or in por�wn at the City offrc�s, <br /> �. Mailed in appiicotinr�s are subjrct ta thc postago Rnd har�dling fecs yhawn betow, permit cnrds wil!bt scnt by <br /> roturn rt�ail thc aama day tho appliceti�n is rcceived. <br /> 3. f'ermtt�are not vA1id until you recclro A permti c�1�d. <br /> 4. Work must not begin unles6 the pert»it card is aveilab{o on the job site. <br /> '�. Utility connoctlon permits mey be issued ta licensed cantracEon only. <br /> 6: Cont:tct thc Public Worics Depariment(473-7357)fot utility atub as-yuiR locetians. DO NO'I'�XCAVAY'F <br /> (N ANY SrR.�F.T AND DU NC�T 7'A}� ANY MAIN without expreas approvaI of t}�c Public Worica <br /> Urpartnlcnt. lssuanca of n pormii does not gr�.nt ihu xpproval. <br /> ?. A1J work must bo dane in eccordtutee with Stat�Codc roquir4mcnts. <br /> 8. All work mu�t ba inapocud before ic is covtred. Cat1473-1357. <br /> 24 hour natkm reqafred. <br /> ,loes�z'T:ADDR.�S.�: • � � <br /> C�ecupAncy Type: Residenti ! Commcr$ial <br /> Qw�,er'e Name: l.�2 L `�^ P6onc Num 5c�- � -Q4�(� <br /> M�iling Addreaa: ' � ,� City: i tUt r� 7�:��Ly�-�. <br /> Coatr�ctor's Name: Phoue Numb� - �� <br /> Malling Addresr: v� City. �cl ��� � <br /> PERMIT TYI'E <br /> Munlcipal S�wcr Coanection($35.00 per atub) �� $ ;�j����r <br /> pip�hixe inchcs; rnateri�l � PVC (ot�sand fli); cesc imn <br /> SAC Char�e($900,(xl)mu�t accom�ny all sewcr pern�it applicacions unless prcpaid, Tf not prtp�id, <br /> a scwcr cuiinec;tion permit will not bc issued. <br /> NYunirl�al Watec Cortnection ($35.00 per stub),,. $ •?�����, <br /> pipe siz�_«____ inches; material,_ I copper; other <br /> WA1�L}2.M�TERS must be picked up und paid fvr at City H�11. � T� � <br /> (S/R" mctcr4 �$I39.00; 3/4" metc� ��191.OQ; 1"mot�rs=�247.00} <br /> Stparatc Plumbing Pcrrrtit issued fot water mettr. <br /> Water metara mu�t be set And aeAled hy Orono Watec Departmont(473-735�qpoa completion <br /> oi meter inst�Il�tlan. <br /> �L�QUIRF,D minimum sett�ack�from drainfieid atid septic tanks=7S' <br /> R�QUIRED aetba�k Frc�m sewer line�20' <br /> ��T�'Fk��A1�.��,A'�[orr <br /> 1. Subtotal of abovc pertnit roquested � °��. �;� <br /> Z� S at� � r�h r�e � S�� <br /> "C'ho State$uildlr�g Code Uivision 6urcharge of S.SO par permlt rtiust be <br /> included far each watt,uwer and water aonnaciina pctmlt requo�ted, <br /> 3. pc�stau�,��dl�n,g(pnly mail-in applicatic�n�) � 1�L^ <br /> 4. TUTA�. PERMiT FEF(add lines 1-3 abovc) $w� , ��� <br /> Tha und�rsigned hercby applies to the Gity of Oraao far issuancr of a Utility Permit,agrees to do <br /> all wark in strict ace�rdance with the ordinaiices of the City and the regul$lions of the Statc nf <br /> Minnesota, and certifies that al!�tatemen�s tnadt an this application are complete, true and correei. <br /> s�gnacurt of Arpl, ����=,�t,ti�" � ���_`-��. <br />