HomeMy WebLinkAbout1996-008516 - sewer connect PERMIT
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(612)473-7357 Date Issued: � {_f�;.Y,�;,��
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REMARKS:
FEE SUMMARY:
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APPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO APPLICATI0�1 FOR UTILITY PERMITS
,, ,_ . 13ox G6 (2750 Kelley Parkway) S�`V�R/WATER
Crystal I3�y, MN 55323
G(:NI;RAL INFORMATION
1. You may apply for utility permits by mail or in person at tl�e City offices.
2. Mailed in applications are subject to the postage and handling fees shown below. Permit cards�vill be sent by
return mail ttie 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 tlie Public Works Department(473-7357)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
Depnctment. [ssuance 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.
JOBSITEADDRESS: C'' �C.�
Occupancy Type: C/" sidential Commerci�l �
Owner's Name: �j�� f,�2titi-�G-�-u Phone Number:_�'c'Y— l'�c7 3�
Mailing Address: �s � � Cityy.,7�'� 7�p: �S.'.S''
Contractor's Name: f .�Z.ry,-�r�e Number: �;��'—�',j�9.
Mailing Address: _�'� . 3�, '1!- � S_�' City:�'Z2ayy�-v� 7�p: ��3� `��
P�RMIT TYPC
Municipal Scwer Connectioii ($35.00 per stub) $
pipe size inches; material��3 PVC (on sand fill); cast iron
SAC Charge($850.0 )must accompany all sewer pennit applications wlless prepaid. If not prepaid,
a se�ver connection permit will not be issued.
Municip�l Water Connection ($35.00 per stub) $
pipe size inches; material copper; other
WATER MF;TERS must be picked up and paid for at City Hall.
(5/8" meters = $139.00; 3/4" meters = $191.00; 1" meters = $247.00)
Separate Plumbing Permit issued for water meter.
Watcr metcrs must bc set and sealed by Orono Water Dep�rtment(473-7357)upon complction
of mctcr installation.
REQUIRED minimum setbacks from drainfield and septic tanks= 75'
REQUIRCD setback from sewer line = 20'
PF,RMIT F�� CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e - $ .50
The State Building Code Division Surcharge of$.50 per permit must be
included for each well,sewer and water connection pernlit requested.
3. Postage & Handlin� (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.
Signatuce of Applicant: � ,,C? � Date: /f,��- ��'