HomeMy WebLinkAbout1994-09-123 Application for Utility Permit•" CITY OF ORONO APPLICATION FOR UTILITY PERK" TS
;;4 42S
Box 66 (2750 Kelley Parkway) SEWER/WATER
Crystal Bay, MN 55323
GENERAL INEOR-TATION
you may apply for utility permits by mail or in person at g e
1
2. Mailed in applications are subject to the postage and handling fees aiil�v .. v. Permit cards will be seat
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.
for
ty stub as -built locations. DO
EXCAVATE
6 Contact the
STREET AND DO NOTTAPANY MAIN rwithout express app oval of theTPublic IN ANY c Works
Department. issuance of a permit does not grant this approval.
7. All work must be done in zccordance with State Code requirements.
8. All work must be inspected before is covered.Call 7357.ura required.
��
JOB SITE ADDRESS: J
Occupancy Type: x Reside
iAi
Owner's Name: H� 1(5
n
Mailing Address: 13 " C: 0 e (A C.;--
Contractor's Name:
Mailing Address:
I CA
Commercial
Prone Number:
City:01( - t'
Prone Number:
1
City: L11 t2
PERMIT TYPE $
Municipal Sewer Connection (S35.00 per stub) cast iron
pipe size inches; material PVC (on sand fill);
permit applications unless prepaid. If not
SAC Charge ($800.00) must accompany all sewer
prepaid, a sewer connection permit will not be issued.
Municipal Water Connection ($35.00 per stub) other
pipe size inches; material copper;
WATER METERS must be picked up and paid for at City Ha;l.
(5/8" meters = $133.00; 3/4" meters = $181.00; 1" meters = $235.00)
Separate plumbing Permit issued for water meter.
Water meters must be set and sealed by Orono Water Department (473-735T, 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 $ .50
2. State Surcharge
The State Building Code Division Surcharge of s.50 per permit must be
included for each well, sewer and water connection permit requested. $ 1 5(1
3. Postage & Handling (Only mail -in applications) $
4. TOTAL PERMIT FEE (add lines 1-3 above)
The undersigned hereby applies to the City of Orono for issuance of a Utility Permit. to
do all work in strict accordance with the ordinances of the City and the regulations e. State
of Minnesota, and certifies that all statements made on this application are complete, tn-e and
correct.xr�, -
Dale:
Signature of Applicant: .(��