HomeMy WebLinkAbout1999-012282 - sewer/water connect � _ PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 _
Crystal Bay, Minnesota 55323 Permit Number: _ ... _. _. _ . . .. .
(612) 249-4600 Date Issued: ::�;_�;�;-;:,�
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REMARKS:
FEE SUMMARY:
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APPLICANT/P MITEE SIGNATURE ISSUED BY:SIGNATURE
'� � CITY OF ORONO APPLICATION FOR UTILITY PERNIITS
Box 66 (2750 Kelley Parkway) SEWER/WATER
Crystal Bay, MN 55323 l 1 �' `� '�
GENERAL INFORMATION
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
retum 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 Public Works Departrnent(249-4600)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
Departrnent. 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. Ca11249-4600.
24 hour notice required.
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JOB SITE ADDRESS: � �C�� �--L�t�u � �v
Occupancy Type: Residential Commercial
Owner's Name: i�c,�, ("� � Phone Number:
Mailing Address: �� �� City: 7�p:
Contractor's Name: � ,� �,.�-,� �� Phone umb.er: `�77- � ��Ck�
Mailing Address: � C �a City: �t 7ip: �s 3 7,j
PERMIT TYPE ��,c,
Municipal Sewer Connection ($35.00 per stub) $ 3� �
pipe size�inches; material �(.��chedule 40 air tested; cast iron
SAC Charge ($1,050.00) must accompany all sewer permit applications unless prepaid. If not
prepaid, a sewer connection permit will not be issued. �
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Municipal Water Connection ($35.00 per stub) $ ��
pipe size�inches; material�� copper; other �
WATER METERS must be picked up and pai�d for at City Hall.
(5/8" meters= $130.00; 3/4" meters= $180.00; 1" meters= $240.00)
Separate Plumbing Permit issued for water meter.
Water meters must be set and sealed by Orono Water Department(249-4600) upon completion
of ineter installation.
REQUIRED minimum setbacks from drainfield and septic tanks= 75'
REQLJIRED setback from sewer line=20'
PERMIT FEE CALCULATION "`'
1. Subtotal of above permit requested $ 7�
2. State Surchar�e $ .50
The State Building Code Division Surcharge of$.50 per pemut must be
included for each well,sewer and water connection pemut requested.
3. Postage&Handling(Only mail-in applications) $ �1'S9�
4. TOTAL PERNIIT FEE (add lines 1-3 above) $ 7C�, >1U
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
NI'innesota, and certifies that all statements made on this application are complete, true and correct.
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Signature ofApplicant: � �- Date: �� —�`'�� � y