HomeMy WebLinkAbout1988-04-28 Permit, Water Well #000760PERMIT
IF
CITY OF ORONO PERMIT TYPE:
1335 Brown Rd. South * P.O. Box 66 Permit Number SEWER & WATER
Crystal Bay, Minnesota 55323 Date Issued: 000760
(612) 473-7357 AA I C-Q
SITE ADDRESS:
1700 FOX r
DESCRIPTION:
Sewer h Water Permit. Type WELL
Sewer & Water WiDrk Type RESIDENCE
FEE SUMMARY:
Ease Fee $ . 00
Surcharge _________-$.�`4
Total Fee $.50
3_
CONTRACTOR:
-- Applicant --
STEVENS WELL DRILLING CO 44792591
"RKS1 N MN 55:359
(E-12) 479-2<9J
OWNER:
MGMILLAN SALLY
WAYZATA
MN 55:391
71
THE UNDERSIGNED HE FB REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS J
'::I'EC I F I ED ANta Au • F T� ► 0�� ALL W� jl1F•; I N 'VTR I CT GiaMF'l_ I ANCE WITH ALL CITY Ijf=
ORO JO ORDIVAkES TATE OFM I NNE c 1 lTA PU I L U I N� :ill): RE' U ME Tc'-
.
APPLICANT PERMITEE SIGNATURE ISSUED BY IG URE
CITY OF OV = APPLICATION FOR UTILITY PERMITS
Box 66 (1335 So Brown Rd) f �' u SEVER HATER WELL
Crystal Bay, MN 55323
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General lastsuotiasa
1. Yon 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 sans 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 t%e 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
STRZZT 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 met be done in accordance with State Code requirements.
S. All work must be inspected before it is covered. Call 473-7357. 24 hout notice
required.
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JOB SITS ADGMSS: Vr
occupancy Types Residential Commercial
01N 18 NMI `%\ �, Al I(( Lj ti Phone No.:
Mailing Address: 1 7 o • r - .L City:
ca RACMIS N 31 _�C V �L. ( BusNo.: 179 } '
Nailing Addresss :�.c c.� �� / City: No.!
Master Plumber's State License No.: City Cert. No.:
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PERMIT TYPS AM M CALCULATION
I ZCIPAL SEWER couna !'ION ($30.00 per stub) $
pipe sise inches; material PVC (on sand fi 1 ; ' cast iron
SAC Charged 0.00) must accompany all sewer permit applfcations unless
prepaid. If not prepaid, a sewer connection permit will not be issued.
I ZCItAL Us= (Ar r or, ( $30. 00 per stub) $
pipe gist inches; :aaterial copper; other
WATER IIg= must be picked up an ppaid for at City Hall.
(5/80 Peters - $95.001 3/40 meters - $130.00)
PRIVWN 10" INSTALI ATIONS ( $ 30.00 per job) $
Check: Mton
Replacement Repair an onment
Casing a se:Inches(Installof new/replacement well covers abandment of old well,
well Abandonment - not concurrent with installation cf new/replacement
well requires a separate permit)
REQUIRED minimum setbacks from drainfield and septic tanke - 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. Sabtotal of above permit requested
$
2. State Surcharge .50
The State Building Code Division Surcharge o 0 per perm t muat e
included foi- each well, sewer and water connection permit requested.
3. postage a dandling (only mail -in applications) $ 1.50
4. TOM pWmIT FM (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: , 4; 1 W `` �L `. Date:�