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APPLICATION FOR UTILITY PERMITS <br />SEMER HATER HELL <br />-^ <br />CITY OP ORONO <br />Box 66 (1335 So Brown Rd) <br />Crystal Bay, MN 55323 <br />*♦♦**♦♦******♦****♦*♦*************♦**♦****♦**♦************♦****♦♦**<'******♦ <br />General Instractions <br />!• You may apply for utility permits by mail or in person at the City offices, <br />2* Mailed in applications arc subject to the postage and handling fees shown below. <br />Permit cards will bo sent by return mail the same day the application is received. <br />3. Permits are not valid until you receive a permit card. <br />4. Work must not begin unless the permit card is available on the job site. <br />5. Utility connection permits may be Issued to licensed contractors only. <br />6. Contact the City offices for utility stub as-built locations. DO NOT EXCAVATE IN ANY <br />STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works <br />Department. Issuance of a permit does not grant this approval. <br />7. All work must be done in accordance with State Code requirements. <br />8. All work must be inspected before it is covered. Call 473-7357. 24 hour notice <br />required. <br />♦♦*♦**★**#***♦*♦♦******♦*♦*>**★*♦*****♦*********♦*****♦*♦**♦************^*** <br />JOB SITE XDDRESS: '.. <br />Occupancy Type: Residential Commercial <br />_ _ _ _ Phone No.:OHNER'S NAME: __ _ _ _ _ _ _ _ _ _ _ _ <br />Mailing Address: Pig ^ <br />CONTRACTOR'S NAME: <br />Mailing Address: /J; <br />City: C^\^5rc*i^ <br />/.y <br />_ Bus. No.: <br />City: 1V\ Tt^ <br />,‘X^'lL <br />Mint-rar rinmhnr'r state License No.: ::Xn Cert. No.: _ _ _ _ _ _ <br />PERMIT TYPE AND FEB CALCULATION <br />MUNICIPAL SBHBR CONNECTION ($30.00 per stub) $_ _ _ _ _ _ _ _ _ ___ _ _ _ _ <br />pipe size inches? material ____PVC (on sand fill); ____^cast iron <br />SAC Charge ($550.00) must accompany all sewer permit applications unless <br />prepaid. If not prepaid/ a sewer connection permit will not be issued. <br />MUNICIPAL HATER CONNECTION ($30.00 per stub) $_ _ _ <br />pipe size _ _inches; material_ _copper; other_ _ _ _ <br />HATER METERS must be piclced up and paid for at City Hall. <br />(5/8" meters = $95.00; 3/4" meters = $130.00) <br />PRIVATE mu INSTALLATIONS ($30.00 per job) $ _ _ _ _ _ _ _ _ _ _ _ _ <br />Chec)c: New _ _ _^Replacement _ _^Repair Adandonment <br />Casing si^e: _ _ _inches(Installation of new/roplacement well covers abandment of old well. <br />Well Abandonment - not concurrent with installation of new/replacement <br />well requires a separate permit) <br />REQUIRED minimum setbacks from drainfield and septic tanks = 75' <br />CALL FOR A SITE LOCATION BEFORE DRILLING <br />Upon completion. City must be sent a copy of State Well Record. <br />1. Subtotal of above permit requested <br />2. State Surcharge .50 <br />The State Building Code Division Surcharge of .50 per permit must be <br />included for each well, sewer and water connection permit requested. <br />3. Postage « Handling (Only mail-in applications) $_ <br />4. TOTAL PERMIT FEB (add lines 1-3 above) $, <br />1.50 <br />The undorBlgned hereby applies to the city of Orono for issuance of a Utility Permit, <br />agrees to do all work in strict accordance with the ordinances of the City and the <br />regulations of the State of Minnesota, and certifies that all statements made on this <br />application are complete, true and correct. <br />Signature of Applicant:,/ ii Q i Date: