HomeMy WebLinkAbout1994-05-11 Application for Utility PermitCITY OF ORONO Al'P.LICAT1ON FOR UTIL11A 1'E1tMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER
Crystal Bay, MN 55323 t
GENERAL INFORMA1ION
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 Public Works Department (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 before it is covered. Call 473-7357.
24 hour notice required.
JOB SITE ADDRESS:
Occupancy Type: Y ResidedillaW
Owner's Name: jt' G' 644 1121 ,�' 1rA 77
Mailing Address:
Contractor's Name:
Mailing Address: f iyp 1T�S S
PERMIT TYPE
Commercial
Phone Number:
City: zips
PlimNumber:
City: < o P t J7e 24K;
Municipal Sewer Connection f�35.00 per stub) $
pipe size � inches; material � PVC (on fit};
SAC Charge ($800.00) must accompany all sewer permit applications unless
prepaid, a sewer connection permit will not be issued.
Municipal Water Comaection ($35.00 per stub)
pipe size inches; material _ _ copper;
WATER METERS must be picked up and p,:.-. for at City Hall.
(5/8" meters = $133.00; 3/4" metti.: = $181.00;
$
other
cast iron
prepaid. If not
I" teeters = $235.00)
Separate Plumbing Permit issued for water meter.
Water meters must be set and sealed by Orono Water Department (473-7357) upon
completion of meter installation.
REQUIRED minimum setbacks from drainfield and septic tanks = 75'
REQUIRED setback from sewer line = 20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. Stateurc r e $ .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) $ 1.50
4. TOTAL PERMIT FEE (add lines 1-3 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. i 64 ��.�^� • �."..� f--�,,.k` �i�
�� `I' Signature of Applicant: ' %�%G�✓F fJ�'�1*��- - — Date: