HomeMy WebLinkAbout1992-004309 - sewer connection P'�RMIT
CITY OF ORONO � �` PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 Permit Number: ''��-y�EF�_� WA7ER
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Crystal Bay, Minnesota 55323 Datelssued: i�S/i�F,/��
(612) 473-7357
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REMARKS:
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APPLICANT/PEFiMITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO APPLICATION FOR UTILITY PERMZTS
Box 66 (1335 So Brown Rd) SEWER WATER
Crystal Bay, MN 55323 � ��
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I:-'You mai y�apply�tor utility perndts by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fees shown below.
PeYmit cards will be sent by return mail the same day the application is received.
3. P�its are nat vali.d until yo�i reoeive a pezmit aard.
4. Work must not begin unless the permit card is available on the job site.
5. Utility connection permits may be issued to licensed contractors only.
6. Contact the Public Works Depart�nt (473-7357) for utility stub as-built locations.
DO NOT F,XCAVATE IN ANY S'IREE,'T AND DO NOT TAP ANY MAIN without express approval of the
Public Works Department Issuanoe of a permit does not grant this approval.
7. A1 1 work must be done in accordance with State Code requirements.
8. All work must be inspected before it is oovered. Call 473-7357.
24 ho�a notive r�,i r��3_
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JOB SITE ADDRESS: �-S ���' `s���w� �'�
Occupancy Type: /� Residential Commercial
OWNER'S NAME: -�-�i��-� r✓��,��z�=��; Phone No. :
Mailing Address: City:
CONTRACTOR'S N�1�: LCi.��i-���'�' 1�ri�_
Bus . Phone: ��'G /�y��
Mailing Address: ,�� . �,� �i � City: 5;�,�;�,�1 Zi ,.5�,.5_3��
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^� P$RMIT TYPE AND FEE CALCIILATION
MIINICIPAL SEWSR CONNECTION ($30.00 per stub) $
pipe size � inches; material PVC (on sand fill ) ; cast iron
SAC Charge ($700.00 ) must accompany all sewer permit applications unless
prepaid. If not prepaid, a sewer connection permit will not be issued.
MIINICIPAL WATER CONNECTION ($30. 00 per stub) $
pipe size inches; material copper; other
WATER METERS must be picked up and paid for at City Hall.
(5/8" meters = $133. 00; 3/4" meters = $181. 00; 1" meters = $235. 00 )
Water meters must be set and sealed by Orono Water Department (473-7357)
upon completion of ineter installation.
REQUIRED minimum setbacks from drainfield and septic tanks = 75'
REQUIRED setback f rom sewer line = 20 '
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l. Subtotal of above permit requested $
2. State Surcharge .50
The State Building Code Division Surcharge of .50 per permit must be
included for each well, sewer and water connection permit requested.
3. Postage � Handling (Only mail-in applications) $ 1.50
4. TOTAL PERMIT FEE (add lines 1-3 above) $
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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 on this
application are complete, true and correct
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Signature of Applicant: � � Q� Date: �.S � � - �/"� -
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