HomeMy WebLinkAbout1993-04-30 Application for Utility PermitCITY OF ORONO 'z iti
Box 66 (135 So Brown Rd) APPLICATION FOR UTILITY PERMITS
Crystal Bay, MN 55323 SEWER WATER
General
tions
1. You may�apply for utility permits by mail or in persor 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 save day the application is received.
3. Pewits are not valid until you receive a permit anrd
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 E}CCAVATE IN ANY SII2 M 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 boor notice required.
JOB SITE ADDRESS:
Occupancy Type:
Tf 6 Alf,
siaentia
commercial
OWNER'S NAME: _ Z110 r( It f Phone No.: `l 33._ 5,/S
Mailing Address: _S,4K1,e City: ,h, �✓l7?��/iC.4 , lrin/ SS.#3
CONTRACTOR'S NAME: L1601I / A Bus. iJbone
Mailing Address: �� rr� City: eVXA. zip:
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3 a cPERMIT TYPE AND PER CALCULATION
MUNICIPAL SEMM CONNECTION ( 36A per stub) $
pipe size inches; material PVC (on sand fill); cast iron
SAC Charge ($700.00) must accompany all sewer permit app-Tcations 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 - $133.00; 3/4" meters - $181.00; 1" meters - $235.00)
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'
1. Subtotal of above permit requested $
2. State Surcharge .50
The State Building Code Division Surcharge o per permit must e
included for each well, sewer and water connection permit requested.
3. Postage a 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.
Signature of Applicant: -
!�' Rate: �J�