HomeMy WebLinkAbout1997-009443 - sewer connection PERMIT
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- PO. Box 66 `�'=�. . WATER
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Crystal Bay, Minnesota 55323 Permit Number: s�;{,;�°, 1;-;
Date Issued: _
(612) 473-7357
, i �:/97
SITE ADDRESS:
480 OLD LONG LAKE '.
F- . . . N . , . i6--11 2:. _`4- 0 -
DESCRIPTION:
SEWER CONNECTION
-F, er _. Water Permit Type SEWER CONNECTION
Wat; r WiDrk `} ypi= RESIDENCE
ENCE
REMARKS:
FEE SUMMARY:
Ease Fg.g, $35 .00
Total Fee 5 . EA)
CONTRACTOR: OWNER:
Y iWATER & : E I% . 28673703 '`_`___- 1 { t({E:_
2760 183RD LA 480
OLD LONG LAKE RD
C.F:1) MN inF011 CTtPC;Nn MN SE:351
(612) 867-3703
THE UNDERSIGNED HERESY REQUESTS PERMISSION TO MAKE THE REAL -„IMPROVEMENTS
SPECIFIED AND AGREES TO DO ALL WORK,,IN STR I `, COMPLI WITH ALL <CITY OF
L
ORONO ORDINANCES AND STATE O '° M MINNESOTA E& Min NG.' CODE a I FSE T'S
I
APPLICANT/P MITEE SIGNATURE ISSUED BY:SIGNATURE j A. ' „
- CITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER 41`4944--
Crystal Bay, MN 55323
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
return 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 Depai t,nent(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.
JOBSITEADDRESS: (En LA k_i:
Occupancy Type: \/- Residential Commercial
Owner's Name: F, las. Horn c,5 Phone Number:
Mailing Address: City: Zip:
Contractor's Name: L �nln'r6.? Phone Number: 753-y35;3
Mailing Address: 2-1 O / 3,d • City: ( At Zip: c / )
PERMIT TYPE
Municipal Sewer connection ($35.00 per stub) / $
pipe size inches; material ✓ PVC (on sand fill); cast iron
SAC Charge($900.00)must accompany all sewer permit 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 Hall.
(5/8" meters = $139.00; 3/4" meters = $191.00; 1" meters = $247.00)
Separate Plumbing Permit issued for water meter.
Water meters must be set and sealed by Orono Water Department(473-7357)upon completion
of meter 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 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 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.
Signature of Applicant: �jjy (fia, /ticrtp.) Date: (1/2_Y/91