HomeMy WebLinkAbout1996-00831 - sewer connection � � PERMIT
! CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66
Crystal Bay, Minnesota 55323 Permit Number: :�:EG�sE� i, WA�E�
(612) 473-7357 Date Issued: i�i;;?::�G
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APPUCANT/PERMITEE SIGNAT E ISSUED BY:SIGNATURE
► " C1TY OF ORONO Al'PLICATION FOR UTILITY PEI2MITS
Box G6 (2750 Kelley Parkway) SEWER/WAT�R �
Crystal B�y, MN 55323 �j f ;
�GNCRAL 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 oniy.
6. Contact the Public Works Department(473-7357)for utility stub as-built locations. DO NO'I'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: �� �� �
Occupancy Type: Residen ial Commercial
Owner's Name: Phone Number:
Mailing Address: C��,: �,
Contractor's Name: Phone N mber: —� QS�
Mailing Address: �0 City: 7�p;
PERM IT TYP�
Municipal Sewer nection ($35.00 per stub) $
pipe size� inches; material PVC (on sand fill); cast iron
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SAC Charge($850.60)must accompany all sewer permit applications unless prepaid. If not prepaid,
a sewer connection permit will not be issued.
Municip�l Watcr Connection ($35.00 per stub) $
pipe size inches; material copper; other
WATER ME"I'�RS 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.
W�ter meters must be set and sealed by Orono Water Department(473-7357)upon comptetion
of ineter inst:�llation.
REQUIRED minimum setbacks from drainfield and septic tanks = 75'
REQUIRED setback from sewer line = 20'
P�ItMIT FCI: CALCULATION
1. Subtotal of above permit requested $
2. State Surcharge $ .50
The State [3uilding Code Division Surcharge of$.50 per permit must be
included for eacl�welf,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 tha 11 statements made on this application are complete, true and correct.
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Signature of Applicant: Date: