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bil l VI VI\VI\V '�' VIL`tfJVJIV V//L// /1 IJ.J/ �' .VL/VL 1\V.VJV <br /> l:i't'Y Ur' U!t(3NU APPLICA�'ION FOR iJTII,ITY PERMITS <br /> Boz Sb (275a K�Itcy P�r�cw�y) SEWEYt�wAT�R <br /> Cryetal Bay, Ml� SS323 <br /> cFH��+�irv�c�#3�TJ,Q�Y <br /> � 1. You rnay apply far utllity pormits by mail or in person at the City affic�s, <br /> Z, Mailed in appl;cutions are subjrct ta thn postago�nd het�dling fccs srhown below. Pertnit cards wil!he s�nt hy <br /> ratuth rpr�il thc aamo day tlso�pplication iY rccoived, <br /> 3. f'ermtt�err not vp11Q untft you recelve�t permtt eArd. <br /> 4. Wurk musl not bcgin unlese th�perniit card is availabla on thc job site. <br /> '�. Utility cunnoction permits may be iss►ud to licensed canitactors only, <br /> 6. Loncs�ct the Public Works pepartment(473-7337j fox utility scub as-buflt lorations. DO NO'f�XCAVATF. <br /> (N ANY S7'R�F.T AND DU NUT 7'AP ANY MAIN without exFraas approval of thc F'ublic Worica <br /> Urpartrrlcnt. lsauanca o!'a pormis does not grw�t thu approvAi. <br /> 7. A11 work must bo done in eccordanco with Statc Codc requircmcnts. <br /> 8. All work must be in�pactec!beforc it ia covtrod. Call 473-7357. <br /> 24 hour aatJco requfred. <br /> ,�oesc-��rAnnx��.�:�C� ���v-I� (..��t� <br /> nccupAncy Type: �R �Ident�al Commerci$1 <br /> Qw�er'� Name: —��a \ �L� ' Phone Num6er: — <br /> M�Utag Addrea8:`1 t��j��- ' --, City:(�� I� . r J� <br /> �ontractur's Nume: v • vi ;'v YhoAeNuraber: � � <br /> Mulling A�dress: `' %� G� • f City. � k ��� a <br /> PERMI, T TYP�: <br /> Munlci�al S�wer Coan�ctiot�($35.00 per stub) / $ <br /> pi�r. hixe �—�" jnches; materi�J 1/ PVC (o�sand fifi); cast iron <br /> SAC Charge($900.0())must accompteny tsll sewcr pcnnit applications unless prcpaid, If not pr�paid, <br /> a scwcr cunn�ctian permit wil! tiot be issued. <br /> 1VYunicl�at Water C`onnection {$35.00�er stub} $ <br /> pipe size inches; matorial copper; ott� <br /> WA1'LF�N1k,TERS must bc piekcd u}�ttnd psid f�r at City FIall. �T <br /> (S/R" metcrs �$J 39.Op; 3/4" metcrs�S 191.OQ; 1"mflters=$247.Ofl) <br /> Separatc Ylumbing Parmit issued fot watcr meter. <br /> Water metcrs mu:t 6c set and ueAlyd�y Orono W�tcr Department(47i-73S�ppon complitjon <br /> of ineter ia�t�llntlon. <br /> }2�QUIRF.D msnimum set�acks from drainfield and septic tanks=75' <br /> R.�QUIRED aetback fr��m s�wor iine a 20' <br /> ��T�`F���'e►�.rr��,AT�i?ri <br /> 1. Subtotal of ab+ovc permit requestcd � <br /> Z� 5�tg_��,h�r e $_ 50 <br /> "f'ho State$ulldlr�g C'ode Uivi�ion 6urchar�e of 5.30 per perm)t must be —~�' <br /> iacludcd far aAch walt,aewer and watrr aonnection petzult requoated, <br /> 3. pasta�c Harldlina{Only mail-in applioatic�n�) $ , 1.50 <br /> 4. 'I'UTAI. PERMiT FkF(add lincs 1-3 ebove) $ <br /> Tha und�rsigned hemb�applic�to the Gity of Or,ono far issuancr of a Utility Per�mit,agrees to do <br /> a11 wark yn st�ict accordancc with the ordinaiices of the City and the rcgulations of the St�ie of <br /> �inr�esotn, and certifies that all�iattmea��tnade un this applicalion are complete, true and correct. <br /> Signature af Arpli _ ��' � �� �:� � y <br /> � <br />