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_ri_iL- �-'�r. TIIE 14 :�_ Ji1�•1E'=� E LEh�h{OF1 r.l•�=4=,;4�1 F' . �_�� <br /> - _ _.. .. . - . <br /> . CITY QF QRpNp - A�PL��A�1V1Y FOR UTILITY PERMITS <br /> , Box 66 (275U ICelley Farkway) SEWERIWq,T�R -- <br /> Crystal B�y, MN Ss323 �-� � <br /> ,.i � �/ � <br /> 1• You may apply for utility pennits by mail or in persQn�t ttie City of�ices. �� <br /> 2� Mailed in�►pplication5 are subject to the post�e and handling fees shown below. Pern�it eards will be sent by <br /> x0turn mail the same day the application is receivcd. <br /> 3� Permitg are not valid until you recejve a ��ermit eard. <br /> 4. Work must not begin unless the permit card is avai[�ble on the job site. <br /> 5� Utility co�nection perrnits m�►y be issued to licensed cootrnctors only, <br /> 6• Cont�ct the PpbIic Works beparhnent(�473-7357) for utility stub as-built iocations. DO NOT EXCA VAT'E <br /> IN ANy STIZE�T ANp DO Np'T TAP ANY MA�N without oxpress approval of the Public Wor�:s <br /> De�artment. Issuance of a permit does not grant this approvc�l. <br /> 7. All work must be done in accordance with Scate Code requirements, <br /> S. All work must be inspectcd before it is covered. Call�73_735?. <br /> 24 haur notjce required. <br /> JOBSIT�ADbRESS: u`� a ��, s � pa,y�� �� <br /> Occu�ancy Type: � Restdentinl Comrnercial <br /> Owner's Name: s�-.�d�� �,� PhoneT[u���r: <br /> Mailing A,ddress: <br /> Cohtractor's N$nne: K �,� ,�� Gity: �� <br /> Phone Number: <br /> Mailiqg �d��css: ���,: <br /> �'�., <br /> P�,�3�ILT TYP� <br /> Municipal Sewer Connection ($35.04 pe� stub) $ <br /> pipe size r inches; material PVC sand fill); east iron <br /> SAC Cllai'g� (�$�0.00}must aCcompany all sewer permat ap�licatiaiis tuyless prepaic�. �f not prepaid, <br /> a sewer connectian pernlit will not he issued. <br /> Munlcipnl �ater Cottnectior� ($35.Qp per stttb) $ <br /> pipe size / , inches; matezial�co�pp�r, other <br /> WATE[Z ME'I'ERS must be picked up and paid for ut City HaII. <br /> {5/8" ineters � $139.00; 3/4" rneters — $191�UO; 1" nleters = $247,pp) <br /> Separate Plumbing Permit issued for water n�eter. <br /> Water meters must be set and sealed by(Jrono Water Dcpartment{�473�735'�upon cornpletipa <br /> af ineter install�tt�on. <br /> �EQUIRED minimum setbacks fxom drainfield and septic tt�nks = 75' <br /> REQUIK�p setbacic from sewer line=20' <br /> � �CUL TI )N <br /> 1, Subtota� of abav� permit requeste�l � <br /> 2• ,�i�te Surchar�e � <br /> The Stake�uilding Code Division Surtharge of�,50 per permit must be <br /> included for each well,sewet and wuter connection petmit rcquasted. <br /> 3� � (Only z�lail-in applications) $__ �1�Q_ <br /> 4. TOTAI, FERMI'Z'FEE (add lines l-3 �bave) � <br /> The undersigned hereby �pplies to the City of Orona for issuance of a Utility permit, p�rees to do <br /> all work in strtct accord�ce with tkae ordinances of the City �d the regulatipns of the State of <br /> Minr,esota, and �e�tif es that all statements made on this appiication arc coinplete, tru� atld c�rrt>ct, <br /> Si�n�ture of Applica Uate:� - / ` �`� <br />