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CITY OF ORON%" APPLICATION FOR UTILITY PERMITS <br />Box 66 (1335 Brown Road So) SEWER WATER. WELL <br />Cry:;tal Bay, MN 55323 <br />General Instructions <br />1. You may apply for utility permits by mail or in person at the City offices. <br />1. Mai loci in applications are subject to the postage and handl rng fees shown below. Permit ca <br />he sent by return mail the same day the application is received. <br />1. Permits are not valid until you receive a permit card. <br />4. Work must not begin unless the permit cord is available on the job site. <br />5. Utility connection permits may be issued to licens^d cuntractors only. <br />t. :.:act the City offices for utility stub as -built locations. DO NOT EXCAVATE IN ANY STR <br />NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of <br />does not grant this approval. <br />7. All work must be dune in accordance with State Code requirements. <br />S. All work must be inspected before it is covered. Call 473-7357. <br />JOB SITE ADDRESS <br />Occupancy Type:__C� Resi <br />OWNER'S NAME a <br />Mailing Address <br />CONTRACTOR'S NAME _ i cl <br />Mailing Address <br />dentia <br />o <br />ommercia <br />Telephone No. -01 <br />Business No. - Ll. <br />State License No. ,Z2011-76" City Cert. No. <br />PERMIT TYPE AND FEE CALCULATION <br />MUNICIPAL SEWER CONNECTION ($30 per stub) $ <br />ripe size inches; material PVC (on sand fill); <br />cast iron <br />Charge ($425.00) must accompany all sewer permit applications unless <br />I:,•id. If not prepaid, a sewer connecticn permit will not be issued. <br />CIPAL WATER CONNECTION ($30 per stub) $ <br />r.i:e inches; material copper <br />_.t,_ <br />WATER METERS must lie picked up and paid for at City Hall. <br />(5/8" meters = $95.00 3/4" meters = $130.00) <br />PRIVATE WELL INSTALLATIONS ($30 per job) <br />check: I_ new well replacement well <br />repair existing well <br />casing size: # _inches <br />REQUIRED minimum setbacks from drainfield & septic tanks = 75' <br />CALL IFR A SITE LOCATION BEFORE DRILLING <br />Upon completion, City must be sent a copy of state well record. <br />1. Subtotal of above permit requested $_ <br />2. State Surcharge $ .50 <br />The State Building Code Division Surcharge of $.50 per permit n,, ,t be includr_d for <br />cac•h well, sewer and water connection permit requested. <br />). 5C' <br />3. Postage and Handling (Only mail -in applications) <br />4. TOTAL PERMIT FEE (Add lines 1-3 above) $ f <br />The undersigned hereby applies to the City of Orono for issuance of a UTILITY <br />PERMIT, agrees to do all work in strict accordance with the ordinances of the City <br />-' _ _. z, ' at :ens of the State of Minnesota, and certifies that all statements <br />f,r; this application are complete, true and correct. <br />