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CITY OF ORONO APPLICATION POR UTILITY PF.RMITS <br /> Box 66 (1335 So Brown Rd) SEWER WATER WELL y��� <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 beqin 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 MAZN 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 /> ****************************************P********************************* <br /> Jos si� Annx�ss�:��..,�lp ('.�L,,_�� v--c;,_� (��.� <br /> Occupancy Type: ,�_. Residential � Commercial <br /> OWN$R'S NAME: Sv}{�J ►�Y� �p,�� Phone No. : <br /> Mailing Addres�.���'� ���,J �t�b � , City: �n L � SS Y�J j <br /> CONTRACTOR'S NAME: ��T�s P_f�� Bus. No. : �.3��3�/�3 <br /> Mailing Address: 3v ��^ �� ,V, City: }-�-�p�j<�..►.S <br /> Master Plumber's State License No. : City Cer�. No. : <br /> • *************************************************************************** <br /> PERMIT TYPE AND FEE CALCIILATION <br /> MONICIPAL S CONNECTION ($30.00 per stub) $ <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 /> M[INICIPAL WATSR CONNBCTION ($30.00 per stub) $ <br /> pipe size inches; material copper; other <br /> WATER METERS must be picked up and paid for at City Hall. <br /> , (5/8" meters = $95.00; 3/4" meters = $130.00) <br /> � ' PRIVAT$ W$LL INSTALI,ATIONS ($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 /> 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 Building "Code Division Surcharge of .50 per permit must be <br /> included for each well, sewer and water connection permit requested. <br /> 3. Postaqe & Handling (Only mail-in applications) $ 1.50 <br /> 4. TUTAL PERMIT FEE (add lines 1-3 above) $ <br /> *********�******************************************************�********�* <br /> The underaigned hereby applies to the City of Orono for isauance of a Utility Permit, <br /> agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulationa of the State of Minnesota, and certifiea that all statements made on this <br /> application are complete, true and correct. <br /> Signature of Applicant ~ �./ Date: / �� /'�v <br /> ..., , <br />