HomeMy WebLinkAbout1982-12-22 Application for Permit, Water Well4.
: 5.
4.
CitYofOROXO
GENERAL INFORMATION
Applleatl**/;f«>r
Utility Permits
V
■•■. .t:/
tew«r water W€ll
Texmit
r«ii My i§‘i tUiUt^ rttPii* by Mi/ cx i« jpciaoh at tht CUy e<fic«*.
U^Ud im wUcaUcii* AXt Aubjtct to tht rcAtayi and handtUs jcc4 ^^lOlCll beta*:,
uttuxn Mi/ tkt Aomt day tht flpr<*ca/iOR ii Rtctivcd,
P/RMITS m N(JT VAIIP JiWTIt you R£CfIl'f A rf£«IT CAW
VCKX uusr kCT B£CI« UWIESS THf F/RMIT CAPP IS AyAItABU CH TME JOB SITE.
U/ifify coRRCC/ioR peti*i/4 may tt inutd to /icefi^cd conXxaetoxA cn/ti.
po"ior EXCAPATE^lS^Aly^STW toT^TAP a Sv ^WA iS*^^^ e*pie*i arP^.ovai oj the Pt/b/i
SSggj
tiSUAMCi OF A rtRMIT POtS A’CT CRAWI THIS APPRORAl.
AU *CR* MUST 8£ PORE IR ACCORPAVCE U'lTH STATE COPE RECUISE«ERTS.-QROWO'
INSTRUCTIONS Ccnpitn at: Utr: c« EAEA appEieatEa*. Co»put« tAe <*€. $40"
--------------------—IWCOUPIETI APPUCAT.OVS tJU ROT 8E PROCESSEP. tt you havt ^uttUeni. catt 47i~1ii7.
WALK-IN PERMITS
MAIL-IN PERMITS
App£{/ at Clttj ,
EiicEoic ijec - h\atZ to:
1335 South BfiOim Road iCty. Rd. 146}
P.O. Sox. 66, Caijitat Saij, h\n. 55323
JOB SITE
Occupancy Type*
ADDRESS ^t^OVmER
t ^ RcAidf«/ifl/ ____ Comme.xcUt Othext ----------------------------------------------------Jl------—--------
___ X*44f4«9 occupied 6uiEdi«3 ____ Me»' con^CeucTcou, not yeC occupied crcy /
Contractor . ■_____ Telephone No.
Mailing Address
City License No.
Wcc -</^ /Ck id
Master Plumber's State License No.
PERMIT TYPE & FEE CALCULATION
MUNICIPAL SEWER CONNECTION (JTO.OP pee *<uk ptue t.SO state SuecAoese • tte.59 eacAl
. pipe Aize ___incfccA; mattxi&l rVC (on Aand iitt);coAt Vion; othtx
APO FOR WC SAC CHARGE* 4//5/u«i/ X uni/4
SAC MUST ACCOHPAWy ALL SEWER TERHIT APPIICATIOWS unliAA phtpaid, J£ pxtpald, 4hc«i ne£tne«Ct toi
Kicetpt U9o __ _ _ _ Sui/difig VtxmU Wc. _ _ Gtntxal Pixmit Ho. _ _ _ _
Permit
SAC
HOTlSr li A Atpaxatt ptumbiny ptKmU muAt be cbtaAnidJox any enA4.dt ckanjeAo
t] CUaneatA r^uAt bt inUatUd at ang/t fccnrfi and toexy ISO iett oi tun.
3) EtiA/ing Atptic tankA rtuAt be purptd and iitltdn
MUNICIPAL WATER CONNECTION (4eV.C0 pm Atub pUa I.$0 stalt Suxchaxgt • IZC.SO cacM
pipe Aizt InchcA; matcxiat coppct, type _ _othtx^incfccA; matexiat __coppct, type
APP FOR WATER METER* 5/E- • $60,00; U*** • 515.00 METERS MOST BE PICXEP UP AT CITX HAIL.
bOrtSi n UiUxA may be puXchaAcd by the contxaztox ex by the pxopexty ovcntx
Permit
Meter
El Wa/ce pctni/A include inApection iox Mc/ct inAtatlation,
be obtained (ox any o/Aet inAide p/umbing changtA,
3|. CuAb Atop muaC be Aft j/uAb to gaound iutjcce.
4) WATER WUST WOT BE TURWEO OW UMTU CITV SEALS METER • CALL WHEW REAPV
A Atpaxatt plumbing ptxmit nuA/
PRIVATE VJELL INSTALLATION (^eo.oo ptx joL pluA 1.50 state Suxtkaxge
i/"
eep/aceiHrnt urc// ____ xtpaix eeiAting u>ett; csAing *ire» __cAecki ntuf H*e//
5E0.50 caekl $ Permit
ilickcA
WOTtSi I) A icpata/e p/uabifig pexmit muAt be obtained ^ox any inside p/umbing cKanqcA.
E) Requited nini«uM te/backip ixomt dxainiietd - 75 Jeet iep/ic tank ‘ 50 <ce/
CALL FOR SITE LOCATIOW BEFORE PRIILIWC
51 Upon comptttion, CITV MUST BE SCMT A COPy OF THE STATE WELL REPORT
state Surcharge Tke state luit<Un$ code VivUien SuecRangc oi St< pea pca.it fia* bee. iaetuded above.
.y\^ : - - -— Total Sueekaxge iox combined watex and.Acieet petuiti i4 51.00
Oa att .ailed.ia apptieatioa*. add tbe paataje aad baadtiaj iee $ 1: 06Postage and Handling
TOTAL PERMIT FEE
V-'
The .adea.ijatd hraeby appfir. to the Cttu oj Caoito (loa
‘itfl/cwcii/A'wadc'^ on tki4' app/ica(4cn ate cemptete; /tue
iiAuance oi a UTJlJTy PERMIT. agxecA to do atl moxb in Atxict
af.tke State -ci iUnntAota, and eaxtiiitA. that atl ^ -
and eoxxeet, ^