HomeMy WebLinkAbout1989-002563 (sewer & water) PERMIT
CITY OF ORONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 Permit Number: L;��;�� L� Wr�T�R
Crystal Bay, Minnesota 55323 Date Issued: �;t}•:';�,:�
(612) 473-7357 1- -
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� APPLICANT;PERMITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO APPLICATION �OR OTILITY PERMITS
Box 66 (1335 So Brown Rd) SEWER WATLR WELL
Crystal Bay, MN 55323
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General Instrnctions
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 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.
8. All work must be inspected before it is covered. Call 473-7357. 24 hour notice
required.
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JOB SIT$ ADDRESS:
Occupancy Type: �� Residential Commercial
OWNER'S NAME: �,T`�'� C�✓-,�'�=-��;��� '� .c' Phone No. : r'� � •- f''�<_5���
Mailing Address. ��; -;•,�> �L.�.�<<, ,,,'�� City: ��%�,-;�,r,�-_
CONTRACTOR'S NAME: C�=�: ��.��:�,� .�%�_ Bus. No. : s%'y� /�'S�..., _
Mailing Address. ,r��: .l � ��` City: ,,; � .,_
Master Plumber's State License No. : City Cert. No. :
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PERMIT TYPE AND FEE CALCDLATION
MONICIPAL SEWSR CONNECTION ($30.00 per stub) $ ,�� • d�
� pipe size inches; material PVC (on sand fill) ; cast iron
� SAC Charge ($550.00) must accompany all sewer permit applications unless
� prepaid. If not prepaid, a sewer connection permit will not be issued.
� � MONICIPAL WATER CONNECTION ($30.00 per stub) $
� pipe size inches; material copper; other
�2 WATER METERS must be picked up and paid for at City Hall.
� � (5/8" meters = $95.00; 3/4" meters = $130.00)
�' �
�: � PRIVATE WELL INSTALI.ATZONS ($30.00 per job) $
� � Check: New Replacement Repair Adandonment
Casing size: inches
(Installation of new/replacement well covers abandment of old well,
- � � Well Abandonment - not concurrent with installation of new/replacement
well requires a separate permit)
c� 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 Bui lding �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 F$B (add lines 1-3 above) $
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The undersigned hereby applies to the City of Orono for isauance of a Otility 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: Date:
... ,
INSPECTION RECORD
CITY OF ORONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 '�'����' `J �'H��'�'
Crystal Bay, Minnesota 55323 Permit Number: {;i s�,��,;�,:;
(612) 473-7357 Date Issued: ���{_y�.,�;_;,�
SITE ADDRESS: APPLICANT:
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PERMIT SUBTYPE: TYPE OF WORK:
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�� DATE �� TIME
CITY OF ORONO CALLED IN ��� � � ���"�—
INSPECTION N T E . SCHEDULED I -��`'�' : 3 c% cv�,
PERMIT NO. �� � COMP TED �L������ —
ADDRES ���' ..J� � % �-�' �i, ��'�—
OWNER " ..i.�vu�-��1 CONTR. �.�_;�.�1 c.��� � ��n C_>
TELEPHONE N0. �-'t�'�`-� r�1 `�
j; C FOOTING ❑ MECHANICAL RI ❑ SITE WELL
~ ❑ FRAMING ❑ MECNANICALFINAL ❑ WELLTESTPUMP
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� i� INSULATION CI FIREPLACEIWOODBURNER ❑ EXCAVIGP.ADINGIFILLING
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Q ❑WALL BD. �WATER HOOK-UP ❑ LAKESHORENVETLANDS
Z ❑ FINAL ❑ MEiER SET(iURN ON ❑TREE REMOVAL
Q ❑ DEMO—SITE ❑SEWER HOOK-UP C SITE INSPECTION
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� G DEMO—FINAL ❑SEPTIC MAINT. ❑ PROGRESS
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� i5 PLUMBINGRI ❑ SEPTICINSTALL. ❑ COMPLAINT
_ [_1 PLUMBING FINAL ❑SEPTIC FINAL ❑ FOLLOW-UP
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� I CORRECT WORK R PROCEED ❑ CITATION ISSUED
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O �.I CORRECT WORK,CALL FOR REINSPECTION C; PROJECT COMPLETE
0 BEFORE COVERING ❑ ISSUE CERTIFlCATE OF OCCUPANCY
Cl CORRECT UNSAFE CONDITION WITHIN HOURS. TEMPORARY
INSPECTOR WILL RETURN
PERMANENT
f l STOP ORDER POSTED.CALL INSPECTOR
C; INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
OwnerlContracto it@�
Inspector. u
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