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CITY OP ORONO APPLICATION FOR UTILITY PERMITS <br />Box 66 (1335 So Brown Rd) SET^fiSR WATER WELL <br />Crystal Bay, MN 55323 <br />************************i^************:k***«*«********************«********** <br />General Instructions <br />1. You may apply for utility permits by mail or in person at the City offices. <br />2. Mailed in applications are subject to the postage and handling fees shown below. <br />Permit cards will 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 contractors only. <br />6. Contact the City offices for utility stub as-built locations. DO NOT EXCAVATE IN ANY <br />STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works <br />Department. Issuance of a permit does not grant this approval. <br />7. All work must be done *?n accordance with State Code requirements. <br />8. All work must be inspected before it is covered. Call 473-7357. 24 hour notice <br />required. <br />***********i^*****ilr*«******«*** ******************************** ************* <br />JOB SITE ADDRESS: /?!'f\ <br />Occupancy Type:Resiaential Commercial <br />OWNER'S NAME: _ _ _ _ _^ <br />Mailing Address; <br />r’jf _s"_. _ Phone No.: <br />City: <br />CONTRACTOR'S NAME: Bus. No.; <br />Mailing Address; /Yu'y b City; <br />Master Plumber's State License no.;City Cert. No.; <br />PERMIT TYPE AND FEE CALCDLATION <br />MUNICIPAL SEWER CONNECTION ($30.00 per stub) $ <br />pipe size inches; material PVC (on sand fill);cast iron <br />SAC Charge ($550.00) must accompany all sewer permit applications unless <br />prepaid. If not prepaid, a sewer connection permit will not be issued. <br />MUNICIPAL WATER CONNECTION ($30.00 per stub) $_ _ _ <br />pipe size _ _finches; material _ _ copper; other_ _ _ _ <br />WATER METERS must be picked up and paid for at City Hall. <br />(5/8" meters = $95.00; 3/4" meters = $130.00) <br />job) <br />Repair Adandonment <br />PRIVATE WELL INSTALLATIONS ($30.00 per <br />Check; _ _ _^New _ _ _Replacement _ <br />Casing size; _ _ _finches <br />(Installation of new/replacement well covers abandment of old well. <br />Well Abandonment - not concurrent with installation of new/replacement <br />well requires a separate permit) <br />REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br />CALL FOR A SITE LOCATION 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 <br />included for each well, sewer and water connection permit requested. <br />3. Postage S Handling (Only mail-in applications) $_1.50 <br />4. TOTAL PERMIT FEE (add lines 1-3 above) $_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br />*************************************************************************** <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 />application are complete, true and correct. <br />Signature of Applicant;D.te=7'?T-<^'P