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Vill VI VI\VI\V '� VIL'TIJV/ IV v//LI/ /1 1�.�/ � .VL/VL 1\V.VJV <br /> , t;l't'Y Ur'UH()NO APPLICA7'ION FOR 17TII,ITY PER1ViITS <br /> � ' ,Boz Sb (275(1 Kelley Prsrkw�Y) SEWER/WAT�It <br /> � Crystal Bay, MN SS323 <br /> I. You may apply fpr utility pc,mits by mail or in person et the City offic�s, <br /> �• ,'Vlailed in applicotiaos art subjrct W tho postago Md hatadling feas yhawn beiow. pormit cards wI!!be acnt by <br /> rcturn rp�il thc samo day thfl appfication i�received. <br /> 3. Pcrmtts erE not valld untll you recclrr s permit cArd. ' <br /> 4. Wurk must not bcgin unless the permit c�rd is avnilabio on thc job site. <br /> '�• Utility tonnection permita mey be isstied ta licensed cnnu�cEors only, <br /> 6. Conts�ct thc Public Works Department(473•7337)for udlity�nib aa-bufit locati�ns. DO T10'I'�XCAVATF. <br /> !N ANY S7'R.�F.T AND DO NpT TAP ANY MAIN without cxpreas wpproval of t}�c Puh)ic Worica <br /> Urpnrtrrtent. lssuance of a permis does�ot grr.nf thu apptnval. <br /> 7. A U work must ba done in accordanee wlth Statc Codo requiron�ents. <br /> 8. All work must ba inspocted before it is coveted. Ca11473-7�57. <br /> 24 hour aotkm required. <br /> �IO8,SI1'F.ADDRESS: J� � � • <br /> Occupancy Type: Resitiential Commtroial <br /> ilwt�er'a� Namc:�I-e,�„e� , ,�D�� Phonc Number: <br /> ---_----�--- <br /> MwUing Addre�a: Cih': 7�p: <br /> �outr�ctor'� Nume: ' phQn�Nu�nber: 5 : ,� <br /> M�rlling Addresa: L•jty• � <br /> PFRil� r TYr , <br /> Munlclpat S�wer Connection($35.OU per stub) $ <br /> pi�e sixo�_ iriches; material�PVC (o�sand fill); cast imn� <br /> SAC Charge(�900,00)must accom�ny all sewer permit applicati�ns unless prcpaid, If not prep�id, <br /> a scwer cu�in�sc;tion permit will nat lx issued. <br /> lYYunlclpal W�ter Cottneetioa {535.00 per stuh} $ <br /> pipa sizc inche�; material copper; fl� ��� <br /> WATL•;}t M�TERS must be pickcd up�end peid fvr$t City FIall. �' <br /> (5/R" mctcrs �$139.00; 3/4" metcrs�$191.OQ; 1" mot�rs=�247.00) <br /> Separat� Plumbing Perrriit issued for watcr meter. <br /> Water meters mu�t b�set And�e�led by Oroan W�ter Department(4yi-735�upon eompktion <br /> of ineter inst�llnttam. <br /> }L�QUtRF,D minimurn setbacks from dra�nfield ecid septic tanks=75' <br /> R�{,�UIRED setback frc�m sewor iine a 20' <br /> p�'. MIT��'.� CA�,�I,,,II.AT'ION <br /> 1. SubtoRal of abflvc permit roquested � <br /> Z, S�a.te,Sc�,ch�}e $ _54 <br /> "T'fie State$uildi�g Code Ulvision 5urcha�e of S.SO por petmit must be <br /> ine3udcd far eacts walt,uwer and watrr aonnection pettnif roquoated, <br /> 3• POS�f���6�111C�(C1nly mail-in applioatic�n�) $ , 1 SO <br /> 4. 'I'UTA�. PERMiT FF,F(add lincs 1-3 above) $ <br /> Tha undor9igned herob� applies to the C'ity of Orono#or issuance of a Utility Permit,agrees to do <br /> all w�ark in strlct acenrdance with the ardinabces of the City and the rcgulations of the Stste nf <br /> Minnos�ta, and certifics that all�tatements tnadc c�n this applicatian are complete,true and conect. <br /> �� � Signateue of Arplicant:_��z%� � ��c_i;ti,�;z�'' 4� . .� �_��- � <br /> _ --�- n�� �, �_� <br />