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bil I VI VI\VI\V � VIL`fIJVJIV V//L// /1 IJ.J/ �' .VL/VL 1\V.VJV <br /> �:1'['Y Ur'U4tt�NU APPLICA7'ION kbR t7�'II�ITY PERMITS <br /> s• , �,� �oz Sb (275t1 Kelley F�rkw�Y) SEWE�tlWATER <br /> Crystal Bsy, M1�1 SS3f� �L�S�3 <br /> GfiHEf3AL[N�'Of,�„M,tT10N <br /> 1. You rnay apply far utiliiy pormits by mail or in person et the City offc�s, <br /> 2. !tilailed in applicati�ns are subjcct tc�thC poacago and har�dling feea yhown below. Permit r�rds wfll be sont by <br /> rotut�rpail the sa[no day tho app}icntion iY rtcciv�d, <br /> 3. PermttY are not valld unt11 yoa rrccivo a permti cArd. <br /> a. Work rtiusl nat begin un�eae the perniit c�sci is svetlabie oa the job site. <br /> �. Utility connoctton permit�may be is�u�d to licensed cnnu�actars only, <br /> 6. Cont�ct thc Public Works Dcpartment(473-7337j for utility atub as-built locatio�s. DO NOT�XCAVA'I'F. <br /> (N ANY S'fR�F.T ANt� DU NpT 7'A}� ANY M�#IN without exproas approvat of the Public 1Worica <br /> UepArtment. Issuance of a pormic doe9 riot grani thu apprpva[. <br /> �. AI! work rnust bo done in accorclance with Siatc Codc requiron�cnts, <br /> 8• All work mu�t bo inapoctod before it fa coverod. Ca11473-7�57. <br /> 24 hour natke rsqutred. <br /> aoesi��r�nn��.�: I�?��� �- -`�<>�'` -�-� ��� �� `i <br /> Occup�ncy Ty�e: � ,�,Residentisl Comm�reial <br /> Uwaer'e Name:�(�;��;C�,�� �f'��'l�#-�('',�1���-i�'1 P�oneNumt�r: <br /> Muiltng Addre�a: ���.; <br /> Coptr�ctar's Nqme: ` �� x� ��+ + ;, -�,��, ,, PhotuNu�ii�r: �`7-�,�� ��'�- <br /> Mulling Addres�: _ � L.��,: �, <br /> PERMIT TYI,;,E <br /> Munlcipa!S�wer Coanectiop($35.OU per stub) $ <br /> pipr.hize�_ ineiles; materisi! PVC (an sand fi1i); case imn r <br /> SAC Charge($900.1X1}must accom�ny uil sewcr petmit applications unless prepaid, If not prtp�id, <br /> �scwcr cuun�c;tion permit wiil not ix issued. <br /> mun{cl�Al Water C'ottneciion (535.00 per stub) $ <br /> pi�� sizc inches; matcrial copper; flther <br /> Wt�►'��LIt Iv1�TERS must bc picked up�znd peid fin at City�Iall. ~� T��T <br /> (S/R" mctcrs a$J 39.Op; 3/4" metcrs��191.Op; 1"mot�rs =�247.00} <br /> SCparatc Plumbing Permit issued fot watcr rneter. <br /> Watcr mcter�mu`t be:et And ae�lcd 6y Orono WRtcr Departmtmt(47i-735�upon compktion <br /> ot metcr iastall�tloa. <br /> 12�QUIRF.I�minimum setbacks from drainfield at�d septfc tanks=7'S' <br /> �t�UIRED actback frc�m s�wor line a 20' <br /> ��T�.�..cA4S�3;A�orr <br /> 1, Subtotal of above permit requested $ <br /> 2, State Gc�rch rae `"�" <br /> s .so <br /> "fho State Auiidi�g Code Uivieio�5urchat�e oP S.SO per perm}t must be <br /> included fnr each watt,sewcr nnd watcr oonnect�on pctmlt roquoated. <br /> 3. pusta�g HandlinQ{Qnly mai!-in applioetic�n�) � �.�pp _ <br /> a. -rorA�. PERMIT FNF(add tincs 1•3�bovc) $ <br /> Thc undorsigned hercby appties to the City of Orono far issuance of e�UtiIity perrnit,agrees to do <br /> aIl wqrk in strict eCcnrdancc with the ordinaiiccs of the City and the rcgul$tions of the Statc nf <br /> I�'�innesot�, �nd certifias thnt al!s temen�s maciC on this agplic.�liQn are complete, true and conect. <br /> � � � ,� <br /> Signatwe of Applieani:_ 1 ;� � Da�e:�!�� ��— <br /> ,. <br />