HomeMy WebLinkAbout06-28-1988 Application for Permit, Water WellAPPLICATION FOR UTILITY PERMITS
SEMER HATER HELL
-^
CITY OP ORONO
Box 66 (1335 So Brown Rd)
Crystal Bay, MN 55323
*♦♦**♦♦******♦****♦*♦*************♦**♦****♦**♦************♦****♦♦**<'******♦
General Instractions
!• You may apply for utility permits by mail or in person at the City offices,
2* Mailed in applications arc subject to the postage and handling fees shown below.
Permit cards will bo sent by return mail the same day the application is received.
3. Permits are not valid until you receive a permit card.
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 City offices for utility stub as-built locations. DO NOT EXCAVATE IN ANY
STREET 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 requirements.
8. All work must be inspected before it is covered. Call 473-7357. 24 hour notice
required.
♦♦*♦**★**#***♦*♦♦******♦*♦*>**★*♦*****♦*********♦*****♦*♦**♦************^***
JOB SITE XDDRESS: '..
Occupancy Type: Residential Commercial
_ _ _ _ Phone No.:OHNER'S NAME: __ _ _ _ _ _ _ _ _ _ _ _
Mailing Address: Pig ^
CONTRACTOR'S NAME:
Mailing Address: /J;
City: C^\^5rc*i^
/.y
_ Bus. No.:
City: 1V\ Tt^
,‘X^'lL
Mint-rar rinmhnr'r state License No.: ::Xn Cert. No.: _ _ _ _ _ _
PERMIT TYPE AND FEB CALCULATION
MUNICIPAL SBHBR CONNECTION ($30.00 per stub) $_ _ _ _ _ _ _ _ _ ___ _ _ _ _
pipe size inches? material ____PVC (on sand fill); ____^cast iron
SAC Charge ($550.00) must accompany all sewer permit applications unless
prepaid. If not prepaid/ a sewer connection permit will not be issued.
MUNICIPAL HATER CONNECTION ($30.00 per stub) $_ _ _
pipe size _ _inches; material_ _copper; other_ _ _ _
HATER METERS must be piclced up and paid for at City Hall.
(5/8" meters = $95.00; 3/4" meters = $130.00)
PRIVATE mu INSTALLATIONS ($30.00 per job) $ _ _ _ _ _ _ _ _ _ _ _ _
Chec)c: New _ _ _^Replacement _ _^Repair Adandonment
Casing si^e: _ _ _inches(Installation of new/roplacement well covers abandment of old well.
Well Abandonment - not concurrent with installation of new/replacement
well requires a separate permit)
REQUIRED minimum setbacks from drainfield and septic tanks = 75'
CALL FOR A SITE LOCATION BEFORE DRILLING
Upon completion. City must be sent a copy of State Well Record.
1. 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) $_
4. TOTAL PERMIT FEB (add lines 1-3 above) $,
1.50
The undorBlgned 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.
Signature of Applicant:,/ ii Q i Date: