HomeMy WebLinkAbout1991-07-25 Application for Permit, Sewer Connect'CITY ON' ORONO APPLICATION FOR UTILITY PERMITS ����
Box tib (2750 Kelley Parkway) SEWER/WATER
Crystal Bay, MN 55323
GENERAL INFORMATION
I. You may apply for 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. Penults are o,4 valid will you receive a permit cord.
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 Gepariment (473-7357) 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 betorc it is covered. Call 473-7357.
24 hour notice required.
JOB SITE ADDRESS:
Occupancy Type: Resldtiltial Commercial
Owner's Name:. A/! � .d.., c . PImwNwnbcr: �/7_- -c 7 -j- I/
Mailing Address: l _ City: ZJp
Contractor's Name:._j PbooeNurnbtr:d/.�IZ
Mailing Address: City: 1,
",c 2, S ,
�RMIT TYpl: "T�—
Municipal Sewer Connection ($35.00 per stub) $
pipe size t inches; material L PVC (on san•J till); cast iron
SAC Charge (581 .00) nwst accompany all sewer permit applications unless prepaid. If not
prepaid, a sewer connection permit will not be issued.
Municipal Water Connection ($35.00 per stub) 5
r:oe size inches; material copper; other
WATER METERS trust be picked up and paid for at City Hall.
(5/8" meters = $133.00; 3/4" meters = $181.00; 1" meters = S235.00)
Separate Plumbing Permit issued for water meter.
Water meters must be sM and sealed by Orono Water Department (473-7357) upon
completion or meter installation.
REQUIRED minimum setbacks from drainfield and septic tanks = 75'
REQUIRED setback from sewer line = 20'
_PERMIT FEE CALCULATION
L Subtotal of above permit requested $
2. State Surcharge $ .50
The State Building Code Division Surcharge of S.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 ah)ve) $
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.
Signature of Applican�: < C' ,�. c _ Dime:z �`' `