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bill vl VI\VI\V '�, VILYfJVJIV V//C// /1 IJ.�/ LJ' .VL/VG 1`IV.V�V <br /> �, - l:l t'Y t,r'U}t{)NU APPLICATION FOR TJ�'ILITY�'ERMITS <br /> Boz Sb (275(f Ke11cy P�rkw�y) SEWEWWAT�R <br /> Cry�tai Bay, MN SS323 <br /> I. You may apply fpr utility permits by mail ar in person 9t the City offic�a, <br /> 2• Mailed in applicutioos are subj�ct tc�thc Roatngo And hat�d)ing feas shown beiow. Pormit c�rds wil!be a�nt hy <br /> raturn mail the aacnc day tho appl;cesiun ix rcccivtd. <br /> 3. Pcrmttt ere not vrild untll you rrceivo�permlt tArd. <br /> a. Wuric must nat bcgin unlrs6 rhe pctmft c�rd is svailabic on thc job site. <br /> 5. tJtility connection permite mey be iset�ed ro i;censed cnntractors only, <br /> 6. Contt�ct thc Public Works pcpartment(473-7337)fot utility an►b es-builc locati��s. DO NO'I'�XCAVATF <br /> fN ANY S'fR.�FT ANU DU NpT TAP ANY MqIN without exproas approval of thc Public Worica <br /> UrpArimcnt. Isauance Af n porrnii does rio;grr.nt thu tipprovA[. _ <br /> 7. Afl work must bo darte in eccordsnco with Staee Code roquircrr�ents. —�— <br /> 8. All wurk must bo in�poctoc!beforc it is covered. Ca11473-7357. <br /> 24 hour naticm requtred. <br /> ��oasi-��r�nDxEss: 8� �i�n �� <br /> Oeeupancy Type: Resfdential Comm�rolai <br /> Qwrier'e Namc: P�� -�� � Phane Number: ``�-�_���33- 3S 7 <br /> M�Iling Addreae: City: �,/�a� 7Jp:��-y�� <br /> �oatracic►r's N�me: � P-� <br /> Malllag Address: 9 c��' Pho�e Nuraber:�� ���3_, � <br /> , <br /> � ��,,�� �. Cc-r- 7I City: `��r`�°.Z� �.� <br /> PERil��TY� <br /> Mttnfclpal S�wer Connection(�35.OU per�tub) $ �� � �z.J <br /> pi�e t;i�e�'_ iricl�es; material PVC (ot�sand filt); cast iron <br /> SAC Charge(�900,{Xl}must accompany�ll sewcr permit applications unless prcpaid, If not prtptud, <br /> �scwcr cuun�ction �ermit wi3! uat bc issued. <br /> Ntuntc[�at W�ter Connection (535.00 per stub) $ <br /> pipe size��__ inches; materiai copper; ot}� <br /> WA 1�LR N1�,TERS must be pic�Ced u��nd paid fvr at City Flall. ���T <br /> (5/R" metcrs �$I 39.00; 3/4" mttcrs��191.OQ; 1" mot�r�_�247.40) <br /> Separatc Plumbing Pemnit issued f�r watcr rneter. <br /> Water meters mu�t be set And:enled 6y OroAo W�tec Aepartmt+nt(Ayi-735�upop compktion <br /> Qi meter iast�llAtloa. <br /> 12�QUtRF.D minimum sett�acks from drainfte3d atid septic tanks= 75` <br /> R�;t,�C)IRED sctbaak fr��m sewor line�20' <br /> ��T�`E��C�cuI,A�[Qrr <br /> 1. Subtotal of abovc permit requested � � �; , �2i' <br /> 2. S_Lte S �r .h ro . $ .50 <br /> �'ho Staie 8uilding CoQe Ulvisioa Surchar�e oPS.34 par permft must be " <br /> 1RC�UdCd f0f 0$C}t WOII,sewer and watrr aonnection potaiit requoated. <br /> 3. po�gYg H ndlin {C}nly mail-in appIioetiuna) $ ,��p <br /> 4. "CUTA�, PERMiT Fk��add lincs 1-3 above) $ <br /> Tha undorsigneci herob�spplies ta the City of Otono for issuancr of a Utiiity per�mit,agrees to do <br /> all wnrk in strict aceordancn wiih the ordinanccs of the City �nd the regul$lions of the State of <br />. MinneBQta, t�nd certifics that aIi�tatcmenis made an this applicatian are complete, true attd correct. <br /> s�g��t���f Arpi,��:_ _ �: �/.�/� � <br />