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CITY OF ORONO APPLICATION FOR 0PERMITS <br />Box 66 (1335 So Brown Rd) SEWER WATER WELL <br />Crystal Bay, MN 55323/ 39 <br />General Instructions <br />1. You may apply for utility permits by mail o": 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 />s. 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 in 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 />*,►*,►**,►*+*****aa******,►*/,/►**�aaa*seas**teas*�*�***eases*,►*****,►***,►�**,►***,►aa <br />JOB SITS ADDRESS: % Y �~ �� % /t & <br />Occupancy Type: Residential Commercial <br />OWNER'S NAME: ./'Y' Phone No.: <br />Mailing Address: City: <br />CONTRACTOR'S NAMBiI%h/ / /1i4 1 Bus. No.: <br />Mailing Address: City: <br />Master Plumber's State License No.: City Cert. No.: <br />assess,taataaaaaaaa*,ta,►+e#earn*yea*+r*ear*aaaaaaaaaa,r,raa,►,taaaaa,raaaaaaa,t,t,e�,►aaaa <br />PERMIT TYPE AND FEE CALCULATION <br />MUNICIPAL SEWER CONNECTION ($30.00 per stub) $ <br />pipe size inches; material PVC (on sand fill); cast iron <br />SAC Charge (5550.00) 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 inches; material copper; <br />WATER METERS must be picked up and paid for at <br />(5/8" meters = $95.00; 3/4" meters = $130.00) <br />PRIVATE WELL INSTALLATIONS ($30.00 per <br />Check: New Replacement _ <br />Casing s z—e:-- inches <br />(Installation of new/replacement <br />Well Abandonment - not concurrent <br />well requires a separate permit.' <br />other <br />City Hall. <br />job) <br />_Repair-Adandonment <br />well covers abandment of old well, <br />with installation of new/replacement <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 />a aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa:aa+ea*aaaaaaaaaaaaaaaaaaaaa,►aa*aaaaaaaaa: <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 i Handling (Only mail -in applications) $ 1.50 <br />4. TOTAL PERMIT FEE (add lines 1-3 above) $ <br />aaaaaaaaaaaaaaaaaaa*a�aaaaaaaaaaaa�..*+►+►aaaa�taaaa+raaaaa*a*aa,►*,ra,►,►t,►�e+►aaa+e*• <br />The undersigned hereby applies to the of Orono for issuance of a Utility Permit, <br />agrees to do all work in strict accr,c:.an a with the ordinances of the City and the <br />regulations of the State of Minnesota, -:.-i certifies that all statements made on this <br />appl.i-ation are complete, true and correct. <br />Signature of Applicant: ; �! Date:./� ~ � ' <br />