2000-P03323 - sewer connection - Laserfiche WebLink

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CITY OF ORONO APPLICATION FOR UTILITY PERMITS Bos 66 (2750 Kelley Parkway) SEWER/WATER Crystal Bay, MN 5�323 GEIYERAL INFORMATION 1. You may apply for utility permits by mail or in person at the City offices. 2. Nlailed in applications are subject to the posta�e and handlin�fees shown below. Permit cards will be sent by return mail the same day the application is received. ;. Permits are not valid until you receive a permit card. 4. Work must not be�in unless the permit card is available on the job site. �. Utility connection permits may be issued to licensed contractors only. 6. Contact the Public Works Department(249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works F Department. Issuance of a permit does not grant this approval. ; 7. All work must be done in accordance with State Code requirements. 8. All work must be inspected before it is covered. Ca11249-4600. 24 hour notice required. JOB SITE ADDRESS: �a4 S l�J��..�� Occupancy Type: �/ Residential Commercial Owner's Name: � c r Phone Number: �/7 3 - 7 0� �L �Iailing Address: � . ��,.�,� ��( City: � R�,u� Zip: s 5 3� I --� Contractor's Name:S�,�,,� N` 5 Phone Number: y73-y.3v� Nlailing Address: �,�,�, �. �-/,,,.,y �U�' City: ',,�. �, _ 7ip: SS �9! PERNIIT TYPE �Iunicipal Sewer Connection ($35.00 per stub) $ -" > pipe size � `�inches; material Schedule 40 air tested; cast iron SAC Charge (2000 rate $1,100.00) must accompany all sewer permit applications unless prepaid. If not prepaid, a sewer connection permit will not be issued. `lunicipal `Vater Connection ($35.00 per stub) $ pipe size inches; material copper; other WATER NIETERS must be picked up and paid for at City Hall. «'ater meters must be set and sealed by Orono`Vater Department(249-4600)upon completion of ineter installation. REQUIRED minimum setbacks from drainfield and septic tanks= 75' REQUIRED setback from sewer line =20' PERtvIIT FEE CALCULATION -��- � ,� 1. Subtotal of above permit requested $ � - 2. State Surchar�e $ .50 The State Building Code Division Surchar�e of$.50 per permit must be included for each well,sewer and water connection permit requested. 3. PostaQe & Handlin� (Only mail-in applications) $ 1.50 4. TOTAL PERMIT FEE (add lines 1-3 above) $ '-S 5 The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all �vork in strict accordance with the ordinances of the City and the regulations of the State of `linnesota, and certifies that all statements made on this application are complete,true and correct. .1- Signature of Applicant: Date: //'2 `!-�