2000-P02658 - sewer connect - Laserfiche WebLink

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i - CITY OF ORONO APPLICATION FOR UTILITY PERMITS Box 66 (2750 Kelley Parkway) SEWER/WATER Crystal Bay,MN 55323 GENERAL INFORMATIOPT 1. You may apply for utility permits by mail or in person at the City offices. 2. Mailed in applications are subject to the postage and handling fees shown below. Permit cards will be sent by return mail the same day the application is received. 3. Permits are not valid until you receive a permit card. 4. Work must not begin unless the permit cazd is available on the job site. 5. 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 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. 7�� - �t77�/ JOB SITE ADDRESS: � �� T"�v� ��yL L��•'�-� Occupancy Type: ��Re idential Commercial Owner's Name: u Z r � Z�� Phone Number: �-7 3-/��-� Mailing Address: -�c° �S � ��c' City: 7°: Contractor's Name: i.,J�'-5d`o,� -� S �. � Phone Number: 4�7�- �St Mailing Address: �^�� C`t� : i� ! 5 City: /l��-�,,.�c� 7ip: 5�36� PERMIT TYPE Municipal Sewer Connection ($35.00 per stub) $ pipe size u�� 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. Municipal Water Connection ($35.00 per stub) $ pipe size inches; material copper; other WATER METERS must be picked up and paid for at City Hall. Water meters must be set and sealed by Orono Water Department(249-4600)upon completion of ineter installation. REQUIRED minimum setbacks from drainfield and septic tanks= 75' REQUIRED setback from sewer line=20' PERMIT FEE CALCULATION ? _ G�� 1. Subtotal of above permit requested $ �S 2. State Surchar�e $ .50 The State Buildin�Code Division Surcharge of$.50 per permit must be included for each well, sewer and water connection permit requested. 3. Posta�e & Handling (Only mail-in applications) $ �- 4. TOTAL PERMIT FEE (add lines 1-3 above) $ �� . �� r% The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made n 's application are complete,true and correct. � Signature of Applicant: Date: �1��