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�� ' ' .,' �i i�Y ur�uxc3�va � � �., �„� � „�,��, � � ,� ,� .,,�,�� ��.,,�� <br /> APPLICATiON FOR 17�'ILITY PERMITS <br /> Box 6b (2750 Keitey P�rkw�Y) SEWE�t1WAT�R <br /> � Cry�t�1 Bay, MN SS3�3 � �� <br /> � <br /> GT,jY�,�,L IN�O�RM,ATtON , l <br /> I. You rnay apply for utility permits by mail flr in pereon at the City ofticea. <br /> �. Msiled in applicotir+as tttt subjcct tc�thn pc>atngo�tnd her�d)ing fees shown below. Pertnit cards wi11 be sont by <br /> rcturn�ail the satno day tho applicntivn i�rcccived. <br /> 3. Permtty are not va1ld until you rtcciYe�permtt cArd. <br /> a. Woric must not begin unlCss the pern�ft catd is availabio on the job sita <br /> �• Uti}:ty cunnoction permits mey be isstied to licensed cnntractors only. <br /> 6. Conts�ct thc Public Works Departmenl(473-7337)far utility atub as-buflt laatians. DO NO'f�XCAVAT'F <br /> tN ANY S't'R�FT AM3 DU NpT T'A}� ANY MAIN without exproas approval of tt�c Publjc Worica <br /> Urpunmcnt. lssuanc�of a pormit docs not grant thu approvAi. <br /> 7. All work must ba done in ecco�ance with Stat�Code roquiraaiertts. <br /> 8. All work must be inspoctod beforc ic is covrrad. Ca11473-7357. <br /> 24 hour notkm reqafred. <br /> �IUBS[7�J:�nDiZ.�qS: � � , r; <br /> Oerup�ncy Type: Reside isE Commerolat <br /> Qw�,er'�Name: C� ' '� P6ona Number:���(—���{Ct <br /> a <br /> M�t11Ing Addreas: t� �. t�-( �,�= City:�„i. �'+�a� �r�7�.����--- <br /> Coptractur's Nume: 'l� (� n 34i,,zP�iPhoueNunxi�r;_ ��:h:�- �-(�;"j� <br /> Mr�ilin Address:' ' �� � •�_ '�� � �• ' ' �� �'� � � <br /> B ���,.�;,s�, Csty: �'s� '� r „ - �Z�p:.�� � ;�� <br /> � <br /> �F�1T TYPE <br /> Munfcipa!S�wer Conn�ction($35.00 per stub $ JJ� C�� <br /> , <br /> pi��sixe�T_ incl�es; rnateri�l PVC (an sand fili); cQst iron <br /> SAC Charge(�900.�10)must accompttny all sewcr pctmit�pplications unless prcpaid, Tf not prep�id, <br /> a scwcr cuiincction permit will nat be issued. <br /> lYYunlcl�at Water Conneciion (535.40 per stub) g�,� "� <br /> pi}�e size `'._ inchea; material�cvpper; �ther <br /> WATLR METERS must be pickcd up und paid fur 8t City�iaU. T ' <br /> (5!8" mctcrs a$139.00; 3/4" metcrs�$191.OQ; 1"mot�rs=�247.¢0) <br /> S�paratc Plumhing Pormit issucd for watcr meter. <br /> Water mctar�muat be set s�qd aeAled 6y Oronn W�thr Aepattmont(4y3-735�qpon comp�stion <br /> ot meter iast�llntian. <br /> �tEQUIRF,D minimum setbacky from drainfteld acid stptic tanks=75' <br /> �QCJIRED sctback frc�m s�war line�20' <br /> p�. M�t..r.I..T..�k...cAL.�LAT1S?�i <br /> 1, Subtotal of abovc perrnit requested � '-7�, ��� <br /> Z. S�te fi�rch rge $ S�� � <br /> "C'ho Stata$ullding C'ode Ulvi�ion 6urcharge of S.SO per permit must be <br /> includad for each wait,aewer and wator aonnectinn�etcuit roquoYted. <br /> 3. pc�sta�c�j�ydl�(pnly mail-in applicatic�n�) $ ,1 SQ <br /> 4. "fUTA�. PERMIT FN�(add lincs 1-3 abov�) $ ��1 .��� <br /> Tha undorsigned hercby appli�to the City of Orano far issuancr of a UtiIity Perimit,agrees to do <br /> all work in strict aCcordancc with the ordins�ccs of the City and the regulati�ns of the Statc of <br /> Minnesota, and certifies that aIl�iaternen�g tnac3e on this apglication are comptete,true and correct. <br /> 1 / <br /> : Signature of Arplican ._ �,��, '� L,,(,� � D�: � - ��-C�'�' <br /> ; , <br /> 1,, <br />