HomeMy WebLinkAbout1988-05-26 Application for Water Well PermitCITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (1335 So Brown Rd) SEWER WATER WML
Crystal Bay, MN 55323
General Instructions
1. 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. 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 Citv 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 t.iis 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.
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JOB SITE ADDRESS: _2o
Occupancy Type: x Res'id,6ntiai Commercial
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OWNStt'S RAMS: -b Phone No.:
Mailing Address: City. _
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CONTRACTOR'S NAME: r .� l C n Bus. No.: q� Z� 3 311 0
Mailing Address BS)4-;2q0 £ rc�rji r��, City: 0r (a, -
Master Plumber's State License No.: City Cert, No.:
PERMIT TYPE AND FEE CALCULATION
MUNICIPAL SEWER CONNECTION ($30.00 per stub) $
pipe size inches; material PVC (on sand fill); cast iron
SAC Charge S550.00) must accompany all sewer permit applications unless
prepaid. If not prepaid, a sewer connection permit will not be issued.
MUNICIPAL WATER CONNECTION ($30.00 per stub) $
pipe size inches; material copper; other
WATER METERS must be picked up and paid for at City Hall.
(5/8" meters = $95.00; 3/4" meters = $130.00)
PRIVATE WELL INSTALLATIONS ($30.00 per job) $
Check: 7< New Replacement Repair Adandonment
Casing size: inches
(Instaliattron-of new/replacement 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 ,ord.
1. Subtotal of above permit requested $�
2. State Surcharge .50
The State Building Code Division Surcharge of .`_0 per permit must be
included for each well, sewer and water connection permit requested.
3. Postage i Handling (Only mail -in applications) $ 1.50
4. TOTAL PERMIT FEE (add lines 1 above) $
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 Applicant: -aJ- l,� uiN� Date: �,_ u