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CITY OF ORONO APPLICATION �OR OTILITY PERMITS <br /> Box 66 (1335 So Brown Rd) SEWER WATLR WELL <br /> Crystal Bay, MN 55323 <br />' � *************************************************************************** <br /> General Instrnctions <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 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 /> *************************************************************************** <br /> JOB SIT$ ADDRESS: <br /> Occupancy Type: �� Residential Commercial <br /> OWNER'S NAME: �,T`�'� C�✓-,�'�=-��;��� '� .c' Phone No. : r'� � •- f''�<_5��� <br /> Mailing Address. ��; -;•,�> �L.�.�<<, ,,,'�� City: ��%�,-;�,r,�-_ <br /> CONTRACTOR'S NAME: C�=�: ��.��:�,� .�%�_ Bus. No. : s%'y� /�'S�..., _ <br /> Mailing Address. ,r��: .l � ��` City: ,,; � .,_ <br /> Master Plumber's State License No. : City Cert. No. : <br /> • *************************************************************************** <br /> PERMIT TYPE AND FEE CALCDLATION <br /> MONICIPAL SEWSR CONNECTION ($30.00 per stub) $ ,�� • d� <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 /> � � MONICIPAL WATER CONNECTION ($30.00 per stub) $ <br /> � pipe size inches; material copper; other <br /> �2 WATER METERS must be picked up and paid for at City Hall. <br /> � � (5/8" meters = $95.00; 3/4" meters = $130.00) <br /> �' � <br /> �: � PRIVATE WELL INSTALI.ATZONS ($30.00 per job) $ <br /> � � Check: New Replacement Repair Adandonment <br /> Casing size: inches <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 /> c� 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 Bui lding �Code Division Surcharge of .50 per permit must be <br /> included for each well, sewer and water connection permit requested. <br /> 3. Postage & Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT F$B (add lines 1-3 above) $ <br /> ****************�********************************************************�* <br /> The undersigned hereby applies to the City of Orono for isauance of a Otility 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: Date: <br /> ... , <br />