HomeMy WebLinkAbout1999-011401 - duplex sewer connect t PERMIT
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�fT`�OF ORONO PERMIT TYPE: .
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2750 Kelley Parkway- P.O. Box 66 `���?E t 5 !r� s��� ��-`°
Crystal Bay, Minnesota 55323 Permit Number: :_i;. ��:;i
(612)473-7357 Date Issued: _
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SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPUCANT-PERMITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO APPLICATION FOR UTII.ITY PERMITS '
� Boa 66 (2750 Kelley Parkway) SEWER/WATER ,
'� Crystal Bay,MN 55323 ,
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GENERAL INFORMATION �
L You may apply for utiliry 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. � i
3. Permits are not valid until you receive a permit card. ,
4. ;:;,1 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. 'y�' � Contact the Public Works Department(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 Pub.lic Works
Departmen� 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 249-4600.
24 hour notice required.
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JOB SITE ADDRESS: �iG� �o.cf� ���---��?i�
Occupancy Type: �Residential Commercial
Owner's Name: .Q�,Q ce�.��- Phone Number
Mailing Address: City: tip:
Contractor's Name: �.����-�- PhoneNumber: 5�5'G ys�s's-'
Mailing Address: �a d x o2/9 City:�S%.C�.�.r�i,�,� 7ap: �5.3�'—
PERNIIT TYPE
Municipal Sewer Connection ($35.00 per stub) $
pipe size_�inches; material chedule 40 air tested; cast iron
SAC Charge ($1,050.00) must accompany all sewer pernut applications unless prepaid. If not
� prepaid, a sewer connection permit will not be issued.
Municipal Water Connection ($35.00 per stub) $
pipe size inches; material copper; other �
WATER METERS must be picked up and paid for at City Ha1L
(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'
REQUIRED setback from sewer line=20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $ �
2. ' State Surcharee $ .50 � __
The State Building Code Division Surcharge of$.50 per permit must be
included for each well,sewer and water connection pernut requested.
3. Postage&Handling(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 Pernut, agrees to do
all work in strict accordance with the ordinances of the City and the regulations of the State of
Muinesota, and certifies that all statements made on this application are complete, true and correct.
Signature of Applicant:/o� v , Date: s'�"'�9