HomeMy WebLinkAbout1993-005111 water connection PEI�IV�IT
CITY OF ORONO r ' � PE�RMIT TYPE:
2750 Kelley Parkway • P.O. Box 815 Permit Number: ������� �j �����
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Orono, Minnesota 55356-0815 Date Issued: t�c�i_;�,;'�:�;
(612) 473-7357
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO `'�r % APPLICATION FOR UTILITY PERMITS
f � Box 66 (1335 So Brown Rd) y - " SEWER WATER
,; j� Crystal Bay, MN 55323
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I: You ma�pply�or 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. P�ennits are nat valid tmtil you reoeive a pP.a�it card.
4. Work must not begin unless the permit card is available on the job site.
5. Utility connection permits ma.y be issued to licensed contractors only.
6. Contact the Public Works Departme.nt (473-7357) for utility stub as-built locations.
DO NOT ExCAVATE IN ANY STREET AND DO NCYr TAP ANY MAIN without express approval of the
Public Works Depaztment. 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 �nspected before it is covered. Call 473-7357.
24 ha�r notioe required.
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JOB SITE ADDRESS: 7�!' /U y�/C��{�v�e�t-'�� j7/�-,��'�
Occupancy Type: x Residential Commercial
OWNER'S NAME: �,v-1�/ �z��=ri-���-���f�� Phone No. :
Mailing Address: City:
CONTRACTOR'S NAML: C���LL=� C-�1la/� Bus. Phone: �7 3/ 3 i��3
Mailing Address: /�p� w�:�.�-� /��ait�v City: /����i3c1,�y Zip: �iz -
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---� P$It1�IIT TYPE AND F$E CALCIII.ATION
MIINICIPAL SEWER 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 from 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 e
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 certif.�es that all statements made on this
application are co�lete, true d correct.
Si nature of A licant: V�'�";"; -� Date: � Gf �/�,�j
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