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FROM : PHONE N0. : 612 477 6208 Aug. 28 2001 08:32AM P4
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<br /> 1. Y.ou`may apply for utiIiry permits by mail or,in person at xhe City offices.. . `
<br /> 2, ,, .. . Mail�d in applicatios�s are subjectio the postage and handling-fee shown below:,Rezmii cards will be sent by.
<br /> � �return ir►ail the same day the application.zs.received , � � .
<br /> 3.. : Perm.its arc not valid untii you receive a per�nit card: � /�
<br /> � 4.: Work imust not begin ublcss the permit card is av.ailable.oni ttie job:site_ � � ��'`
<br /> 5.: Util�ty connection permits may be issued io licensed contractors only, =
<br /> 6;. ~ Contact th�e Public Works Department (952-249�600) for utality stub as-built locations. DO NOT
<br /> � EXCAVATE YN ANY STREBT AND DO NOT TAP.�N'Y MAIN without express approv�l of tk�e Public
<br /> Works Departmez�t_. Issuance of a permit does not giant this a�pro�val.
<br /> � 7., All work must be done in accordance witli State Code.requirements. ! � � r-�
<br /> .. g; ,All work must be inspected beforc it is covered. Call(952)249-4600. ,_ `
<br /> � �. 24 hour notice required. � �� � I
<br /> L � f�,� �� l,.
<br /> �OS SXTE ADDRESS: J� � `� � \t/i n s"�� �f �� `�
<br /> Occu anc T e: ✓ Residential Commercial
<br /> p Y Y� r
<br /> Owner's Name: ��. Pho�ie Number���i��•����a 7�'��
<br /> Mailing Address: % 3 � . City: �P'�� c��
<br /> � Contractor'sName: q Phone u�onbe .�1�3 �i'� � �
<br /> 1VlailingAddress: D4d ,d . C City: 7Sp:�S�7�
<br /> pFY2MIT T'YPE 3 S, a v
<br /> � Municxp,al Sewer Connection ($35.00 per stub) $
<br /> - �ipe..size�inches; . m�terial � Schedule 40 aii tested; cast iron
<br /> SAC Ckaarge (2000 rate $1,7.50.00) must acco.mpariy all se�rrer permit applications uzxless prepaid.
<br /> If not prepaid; a sewer connectxon permit will not be issued.;
<br /> �
<br /> Municipal Water Connect�on ($35:00 per stub) � � $ �� ' �v .
<br /> . � pi�e-size�_inches; matenal �copper; other
<br /> . � WATER METERS must.be picked up and paid for at City,kIall. '
<br /> Water meters must be set:and :sealed.by Orono Water bePaetment (952-249-4600) upon
<br /> completion of ineter instaUation:
<br /> REQUIR�A minimum setbacks froz�.drain field and septic tanks=75'
<br /> REQUIRED setback from sewer line-20' .
<br /> �ERMI ub otal of aho eLATiON uested- - . . , . .
<br /> „ . P permit r q . � $ 7�.d�
<br /> � 2. State Surchar�e $ .50
<br /> ' . The State Building Code Division Surck�arge of$.50 per permit must be
<br /> � `included for each well,sewer and wAter connection permit requesced. �
<br /> 3: Postage &Handlin�(Only mail-in applacatioz�s) $ �-58'- �
<br /> . 4. TOTAL PERMIT FEE (add lines 1-3 above) $ O -
<br /> The unders�gned hereby applies to t)ne City of Ozono for issuance of a Uti�ity Perm�it, agrees to do
<br /> a11 wozk irz strict accordaz�ae with the ordinances of the City az�.d the regulations of the State of
<br /> Minnesota,and certifies that all statements made on this application are comp�et�,true antd correct..
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<br /> Si�o.ature of Applicant:, �, �"G%� �fi ` � �-t Date: � ���'l r
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