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�.-� � � �.rr vxunv APPL,ICA'�'ION Ft�R i7TILITY YERMITS <br /> Box Gb (275(1 Keiley F�rkw�y) SEWEYtlWAT�R <br /> Cry�taf Bay, MN 553�3 5'A�G Pd <br /> � ��A . �,�� ��n <br /> ���Y�� 2I���o� <br /> � You may apply for utility perrnits by mail ar in person ar the City ofEices, <br /> �. Mailed in appll�ntiaos are subjcct to thn poatago ytnd hasadling feaa yhawn below, f'ormit cnrds w!1!be sont by <br /> rcturn rtieil the same day tha app)icat3un ia rec�ived, <br /> 3• Permits are reflt va11d untl3 you recelYe a permtt cArd. <br /> a• Work mu�Y not bcgin unles6 the prrtnit ca�rci is evailablc on the job site. <br /> S. Utility cunnoction permits me�- be issued to licensed cnnrracton onlv, <br /> 6. Contuct th� Public W'orks Department (473-7337)fa�utility etub as-buflt locati��ns. DU NO"I'bXCAVATF <br /> [N ANY S7'R�'F.T RN�: DJ NaT ;'AF I`.NY NiAilv without cxprebs approval o; tt�o Public wo�ks <br /> UrpAftt11cr1t. lssuartce of n perrrii;does not gra.n2 thu approvA;. <br /> - Ali work must ba dcmc ir; eccordance with Stat�Code rcqairen�cnis. <br /> 8. Ali work must bo impocud betorc },is covered. C&11 473-735 i. <br /> Z4 hourttotico roquEred. <br /> �)Ussc"t�raUnuESs: loD S�. c�( <br /> t�ecupanc�� Type: � Cou�mtrc�iat <br /> (?w�e�'� ?�I�!mr:�_L-�c,�-, �'QM� P��:�c Numt:er: <br /> M�IJin� Addreas: �� �ity' ��, <br /> Coufr�ctar's Nume: v�.�. �1 Phant Number:�s�v1c G G•< Zs� <br /> Mallittg Addresa: C'�� -1�— 3� -f-• Cih':5�-v,,�ct�,.�� �p;�Go <br /> �'E�,'1M'IIT �'YI�� ec� <br /> Munlcip�t Sa��er Conneetfo� (�35.00�per stubj b $ 3S • �- <br /> pi�r. size��` -- inci�es; materia?�G�i��P�'C (or sand fIl); cas: iror._._.�� <br /> SAC Chr�rge(�900,OU; mus:n�compftny tili sewcr pernzit�zpplications unless prcpaid, If noE preptxid, <br /> s scwcr coun�ction permit wii? nat be issued, <br /> I17unfct�ni Weter �'onneciion (535.0� per stub) $ <br /> pi�e size�� inches; material copper; other <br /> WA3�LR�v1�;TERS must be picked up und paid fvr at eity�iall. T �� �T <br /> (5/R" mctcrs � $139,00; 3/4" metcrs �$191.OQ; 1" mottlrs=$247.00) <br /> Separat� Plumhin� Pcrmit issued for watcr meter. <br /> Watcr metcr�mu�t bo set s�nd aeAled 6y Qronu Wsttcr Bepartment{473-735�qpon compktlon <br /> o€metcr iast�tlAtiom. <br /> �t�QUIRF.I)minimum set���ks from drainfield and septic tanks=75' <br /> Rl;{,1CJlRED sctback from sewor Iiue �20' <br /> P - MIT ��F�: �.AI�.CULATION <br /> 1. Subtotal of above portnit rcquestcd � <br /> Z. St�te Su� rc,�o�e $~ _50 <br /> "t'he State Suilding Code Ulvision 6urcharge of S.30 par petmit must bt <br /> ine3uded for eRch wait,sewt.r atrd watcr aonnection potmlf raquoatcd. <br /> 3. �'UStgue& Haridlina (Only mail-in applioatic�n�j $ , ] SO p <br /> 4. "I'UTAI. PERMiT FNF(sdd lines 1-3 above) $ �� � <br /> The undnrsigned heraby applies to t.he City of Orono far issuancc of a Utility Permit,agroes io do <br /> all work in st�ict acenrdance with the ordina�ces of the City and the rcgulations of the Statc nf <br /> I�inneaota, and certifics that aI!atatrn�en�s;nerlc ur�thi�app!icati�n ase co:nplete, i-ue�nd correcf. <br /> sig��t��af Arpis��r: � �: 5r,/y� _ � <br />