HomeMy WebLinkAbout1996-008057 - sewer connect � PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 '_��.�!��; `�� �.�'��F'
Crystal Bay, Minnesota 55323 PermitNumber: �;�:;;_;�.;�;�
(612) 473-7357 Date Issued: t�7F,r�:�;�.=�F,
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE T/�,
Cl'1'Y OF ORONO APYLICATION T�3l12 UTILITY PERMI'I'S ��,5�'���r
I3ox GG (2750 Kelley Parkway) S�WER/WAT�R
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Crystal 13ay, MN 55323
ccrrraA� iNro�imnT�orr
l. 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 tlie 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 perniits may be issued to licensed contractors only.
6. Contact the 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
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.
JOBSIT�ADDI2�SS:
Occupancy Type: � Resi ia Cominercial �
Owner's N�me: Phone Number: - �5-
Mailing Address: City; 7�p•
Contractor's Name: .� PhoneNu er: yy� iy�
Mailing Address: City: �' 71p' S��'��5—
P�IZMIT TYPE
Municipal Sewer Con ection ($35.00 per stub) $
pipe size��nches; material_��'VC (on sand fill); cast iron
SAC Charge($850.00)must accompany all sewer permit applications unless prepaid. If not prepaid,
a sewer connection permit will not be issued.
Munici�al Water Connection ($35.00 per stub) $
pipe size inches; material copper; other
WATER MF,"1'LRS 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 mctcrs must be set and sealed Uy Orono Watcr Department(473-7357) upon completion
of ineter install;�tion.
REQUIRED minimum setbacks from drainfield and septic tanlcs = 75'
REQUIRED setback from sewer line = 20'
P1�;RMIT rI;C CALCULATION
1. Subtotal of above perinit requested $
2. State Surchar�e $ .50
The State [3uilding Code Division Surcharge of$.50 per permit must be
included for eadi well, sewer and water connection permit requested.
3. Postage & IIandline (Only mail-in applications) $ 1.50
4. TOTAL I'ERMI'r 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 regul�tions of the State of
Minnesota, and certifies that all statements made on this application are complete, true and correct.
Signature of Ap��licant:_,�=���������, Date:����� _��'
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