HomeMy WebLinkAbout1993-005150 - sewer connect ►
PEI�MIT'
CITY OF ORONO PERMIT TYPE: : t4�. , ��-1
2750 Kelle Parkwa • P.O. Box 815 '�'i���'° `_ ' :.-`
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Orono, Minnesota 55356-0815 Date Issued:
(612) 473-7357 `-}�':+ ��':�_�:_:
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APPLICANT/PERMI NATURE ISSUED BY:SIGNATUFE -l'-�i
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CITY OF ORONO APPLICATION FOR IITILITY PERMITS
� Box 66 (1335 So Brown Rd) SEWER WATER
Crystal Bay, MN 55323 �
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I; You may�pp�or 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.
Perniit cards will be sent by return mail the same day the application is received.
3. Pe.imits are mt valid iurti.l y�ou reoeive a peYmit 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 Public Works Dep�stment (473-7357) for utility stub as-built locations.
DO NOT EXCAVATE IN ANY SIREET 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. Cal 1 473-7357.
24 ho�ir natioe required.
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JOB SITE ADDRESS: �-� �' � ��,/� ' � r ��
Occupancy Type: � Re i ential Commercial
OWNER'S NAME: % � = ; /�,� Phone No. :
Mailing Address: City:
CONTRACTOR'S NAME:�-�j r �-- ��� �"�i�;�,�� ,;_ =�" Bus . Phone: � � - ` � �/
Mailing Address: ��,c � - � , ,,., ., � , ` � �% � Zi f��?�l.
� � � � City:`„ J, p:
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�; .�;'r_PERMI T TYPE AND F$S CALCUI�ATI ON
MIINICIPAL SEWFR CONNECTION ( $�$0 per stub) $ %•- �
pipe size ��..��inches; material �% PVC (on sand fill ) ; cast iron
SAC Charge f$700.00 ) must accompany al l sewer permit applications unless
prepaid. If not prepaid, a sewer connection permit will not be issued.
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MIINICIPAL WATER CONNECTION ( $-�II�O 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 co�nnpletion of ineter installation.
REQUIRED minimum setbacks from drainfield and septic tanks = 75 '
REQUIRED setback from sewer line = 20 '
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1. Subtotal of above permit requested $ f �; � /'
2. State Surcharge . 50
The State Building 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 FEE (add Iines 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 co�lete, true an�correct. ; _
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Signature of Applicant:%� ���-�, �<%���� 'L - _ - Date: � ^ / / - /-�
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