HomeMy WebLinkAbout1988-09-06 Application for Utility PermitCITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (1335 So Brown Rd) SEWER WATER WELL
Crystal Bay, MN 55323
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1. You may apply for utility permits by mail or in person at the City offices.
2. Mailed in applications are subject to the ,ostage and handling fees shown below.
Permit cards will he 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 finless the permit card is available on the job site.
5. Utility connection permits may be issued to licensed contractors only.
6. Contact the City 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 this approval.
7. All work must be done in accordance with State Code requirements.
S. All work must be inspected before it is covered. Call 473-7357. 24 hour notice
required.
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JOB BITE ADDRESS: I-14 2) - F ,F o'E 9-#.:)C- SS P O! tiT I�
Occupancy Type: _ Residential _ Commercial
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Master Plumber's Str.te -,icense No.: -OP ity Cert. No.:
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PERMIT TYPE AND FEE CALCULATION
MINICIPAL S1 10 CONNECTION ($30.00 per stub) $
pipe size inches; material PVC (on sand fill); cast iron
SAC Charge 550.00) mu3t accompany all sewer permit applications unless
prepaid. If not prepaid, a sewer connect'—i permit will not be issued.
MUNICIPAL WATER COMNNCTION ($30.00 per stun) $
pipe size inches; material ti 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 IBSTALLATIONS ($30.00 per job) $
Check: New Replacement Repair Adandonment
Casing size: inches
(Installs on 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 Record.
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1. Subtotal of above permit requested $
2. State Surcharge .50
The State Building Code Division Surcharge o .50 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 1-3 above) $
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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.
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Signature of Applicant:p,_, /) {. '» *14; lr %Vc�: Date:: ? A
NOW