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, . ��? �, <br /> CITY OF ORONn ,,,, APPLICATION FOR UTILITY PERMITS <br /> Box 66 ( 1335 Brown Road So ) SEWER WATER WELL <br /> Crystal Bay, MN 55323 <br /> *********************�**************************************************** <br /> General Znstructions <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applicationsare subject to the postage and handlingfees shown below. Permit cards will <br /> be sent by return mail the same day the application is received. <br /> 3. Permits are not valid until you receive a permit card. <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 contzactors only. <br /> 6. Contact the City offices for utility stub as-built locations. DO NOTEXCAVATE IN ANY STREETAND DO <br /> NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a permit <br /> does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> B. All work must be inspected before it is covered. Call 473-7357. <br /> �c�c***ic**�t�t�k*�k�t**�t�t�t�k*�t�rir*�t**�t�c*****ir******ic**icic�lcic*ic�t�t****�c****�k**�t***�ic�t*�k�t <br /> JOB SITE ADDRESS � � � ��,� <br /> �/__C) i ��r. CGi✓i.�)�-ru � <br /> Occupancy Type : �_ Res"' dential Commercial <br /> OWNER'S NAME �,n�,�.,i,�� �'p,.��� x�'�� d� Telephone No. <br /> Mailing Address ;���,� �,,���._,;,,r, A J�cY.-. <br /> CONTRACTOR'S NAM��Mp:�,�� ��., ��;��. (1cr�_ Business No. �j�. ��r'��� <br /> Mailing Address l�c�� � M-1-1��. Z,���.t �-�-�;�� .a. �� u �53y� <br /> Naster Plumber ' s State License No. M��1�'� City Cert. No. ����_ <br /> ************************************************************************** <br /> PERMIT TYPE AND FEE CALCULATION <br /> MUNICIPAL SEWER CONNECTION ( $30 per stub) $ �Lx� <br /> pipe size inches; material PVC (on sand fill ) ; <br /> cast iron <br /> SAC Charge ( $425 . 00 ) must accompany all sewer permit applications unless <br /> prepaid. If not prepaid, a sewer connection permit will not be issued. <br /> MUNICIPAL WATER CONNECTION ( $30 per stub) $ �� �Lj <br /> pipe size inches; material copper <br /> other <br /> � <br /> W�TER METERS must be picked up and paid for at City Hall. �,�;� <br /> �(5/8'? meters = $95. 00 3/4" meters = $130 . 00 ) <br /> _� <br /> PRIVATE WELL INSTALLATIONS ( $30 per job) $ <br /> check: new well replacement well <br /> repair existing well <br /> casing size : inches <br /> REQUIRED minimum setbacks from drainfield & septic tanks = 75 ' <br /> CALL FOR A SITE I.00ATION BEFORE DRILLING <br /> Upon completion, City must be sent a copy of state well record. <br /> ************************************************************************** <br /> 1 . Subtotal of above permit requested $ � ��� �,,�� <br /> 2 . State Surcharge $ . 50 <br /> The State Building Code Division Surcharge of $. 50 per permit must be included for <br /> each well , sewer and water connection permit requested. <br /> 3 . Postage and Handling (Only mail-in applications ) $ 1 . 50 <br /> 4 . TOTAL PERMIT FEE (Add lines 1-3 above ) $ /,�'7� �� <br /> ************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a UTILITY <br /> PERMIT, agrees to do all work in strict accordance with the ordinances of the City <br /> and the regulations of the State of Minnesota, and certifies that all statements <br /> made on this application are complete, true and correct. <br /> �, c <br /> Signature of Applicant 1J�C,G��cti pr; �► Date : �`�-�`-�-�°) � <br />