HomeMy WebLinkAbout1993-005022 sewer connection ' PEI�MIT
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+ ' CITY OF ORONO PERMIT TYPE: ,«.��,�� �� ,��-���
2750 Kelley Parkway • P.O. Box 815 Permit Number: i;i�,i����
Orono; Minnesota 55356-0815 Date Issued: i y::;I:=:i�j•�:::
(612) 473-7357
SITE ADDRESS:
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CA � RMITEE SIGNATURE ISSUED BY:SIGNATURE��
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. G�ITY OF ORONO APPLICATION FOR DTILITY PERMITS ,
� Box 66 (1335 So Brown Rd) SEWER WATER
Crystal Bay, MN 55323
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i: You ma�yt 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.
Pernnit cards will be sent by return mail the same day the application is received.
3. Peimits are nat valid imtil yoRi reoeive a pe�it card.
4. Work must not begin unless the permit card is available on the job site.
5. Utility oonnection permits may 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 STREE`I' 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 requireirtients.
8. Al1 work must be inspected before it is covered. Call 473-7357.
24 haur mtioe required.
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JOB SITE ADDRESS: ��' ��- I U���
Occupancy Type: 1/`�esidenti Commercial
OWNER`S NAME: � � �/ �� L -�� Phone No. :
Mailing Address: / _� City:
CONTRACTOR'S NAM$: ��`��,Z ��wl�/�-"� B u s . P h o n : � ' � ��;Z �
Mailing Address: � City: Zip: � '�`/,v..�-�
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�ss o�-b PffitMIT TYPE AND FEE CALCDLATION
MIINICIPAL SEWER CONNECTION ($34-:-00 per stub) $
pipe size inches; material PVC (on sand fill) ; cast iron
SAC Charge ($700.00 ) must accompany all sewer permit applications unless
prepaid . If not prepaid, a sewer connection permit will not be issued.
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MIINICIPAL WATER CONNECTION ($�-�-$@'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 campletion of ineter instal lation.
REQUIRED minimum setbacks from drainfield and septic tanks = 75'
REQUIRED setback from sewer line = 20 '
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1. 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 FE13 (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,�.an`d ertifies that all statements made on this
application are complete, true and �ect.
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Signature of Applic , _ ate���/��y-�,2�'_�
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