HomeMy WebLinkAbout1990-003220 - sewer/water connect . hsF .
, PERMIT
CITY OF ORONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 Permit Number: �``��f�� �� ����fi
Crystal Say, Minnesota 55323 Date Issued: �jt a �, ��}
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(612) 473-7357
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APPLICANT PERMITEE IGNATUR � ISSUED BY SIGNATUHE
CITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (1335 So Brown Rd) SEWER WATER WELL
Crystal Bay, MN 55323
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General Instructions
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 nntil pon reoeive 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 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 Wozks 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 honr notice reqnired.
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JOB SITE ADDRESS: �-S � �-1 C.� '� 5 U �- � �% � /�C� � 1 C /�
Occupancy Type: Residential Commercial
OWNER'S NAME: �C.�c.r�'� r �o��1S'�• Phone No. : � ��, ' � � � 5
Mailing Address: 7c���� , ,-os �,�J � . City: ;�rr.aKl'r'i� C���cc-
CONTRACTOR'S NAME: /�(�a�k�` C� �;���w�c� ExL• Bus. Phone:
Mailing Address: �/'�e,�, ��[S� �u, rv� City: �'r�.K�Y,u �:;� Zip: 5 � '�
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PERMIT TYPE AND FEE CALCIILATION
MIINICIPAL SEWER CONNECTION ($30.00 per stub) $
Fipe size inches; material PVC (on sand fill) ; cast iron
SAC Charge ($575.00 ) must accompany all sewer permit applications unless
�repaid. If not prepaid, a sewer connection permit will not be issued.
MIINICIPAL WATER CONNECTION ($30.00 per stub) $
�ige size inches; material copper; other
WATER METERS must be picked up and paid for at City Hall.
(5/8" meters = $111.30; 3/4" meters = $146.28 )
Water meters must be set and sealed by Orono Water Department (473-7357)
upon completion of ineter installation.
PRIVATE WELL INSTALLATIONS ($30.00 per job) $
Check: New Replacement Repair
Casing size: inches
REQUIRED minimum setbacks from drainfield and seFtic tanks = 75 '
REQUIRED setback from sewer line = 20 '
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 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 PERIrIIT F$E (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 A�plicant: �1--.�� � Date: �j � _5 � `%��
CDATE TI(NE
CITY OF ORONO CALLED IN �� �' �d a�-
INSPECTION N�TICE SCHEDULED �' v �'�'
PERMIT NO. aoZ-b COMPLETED �1
ADDRESS � �� S r`
OWNER ONTR.
TELEPHONE NO. °�'� -� � gv
�`, ❑ FOOTING ❑MECHANICAL RI ❑SITE WELI
~ ❑ FRAMING ❑MECHANICAL FINAL ❑WELLTEST PUMP
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Q ❑ INSULATION ❑FIREPLACE/WOOD BURNER 0 EXCAV/GRADING/FILLING
y ❑WALL BD. ❑WATER HOOK-UP ❑ LAKESHORFJWEfLANDS
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Z ❑ FINAL ❑MEfER SEf/TURN ON ❑TREE REMOVAL
Q ❑DEMO—SITE �SEWER HOOK-UP �SITE INSPECTION
� ❑ DEMO—FINAL ❑SEPTIC MAINT. ❑ PROGRESS
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W ❑ PLUMBING RI ❑SEPTiC INSTALL. O COMPLAINT
_ ❑ PLUMBING FiNAL ❑SEPTIC FINAL ❑ FOLLOW-UP
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O ❑CORRECT WORK,CALL FOR REINSPECTION ❑ PROJECT COMPLETE
� BEFORE CONERING ❑ISSUE CERTIFICATE OF OCCUPANCY
❑CORRECTUNSAFECONDITIONWITHIN HOURS. TEMPORARY
INSPECTOR WILL RETURN
PERMANENT
O STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
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Owner/Contra on i e:
Inspector.
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