HomeMy WebLinkAbout2008-00021 - septic repair �i� � � �'
� �" CITY OF ORONO PERMIT NO.: 2oos-0002i
2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE ISSUEn: 07/3U2008
952 249-4600 FAX: 952 249-4616
ADDRESS : 2685 RAINEY RD
PIN : 04-117-23-43-0013
LEGAL DESC : TREES TO BE
: LOT 002 BLOCK 001
PERMIT TYPE : SEPTIC
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : REPAIR
NOTE: CONTRACTOR WILL REPLACE WHAT IS NECESSARY
/
APPLICANT SEPTIC REPAIR 50.00
HAYES& SONS EXC. INC. STATE SURCHARGE SEPTIC 0.50
263 82ND STREET S.E.
MONTROSE,MN 55303 TOTAL 50.50
�)
Minnesota State License#: 640
OWNER
VICKERMAN, SCOTT& SUSAN
2685 RAINEY RD
WAYZATA,MN 55391
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance wi[h the State Building Code.This permit may be
,r�v�ke��tim f due cause.
_� � � �� / O .�'' C�i���LQ.t2 /.� �l �
Applicant P Signature Date I ed By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
� � '�. /
� City of Orono i/ FOR CITY USE ONLY
�4 0\ P.O. Box 66 �D '
�,,,r,. � 2750 Kelley Parkway �J�� Date Received: Permit#o2o'O�– DO o2/
��� ��Y�',��,i`'�. F ' Crystal Bay,MN 55323 4
�����Fp4�o` (952)249-4600 Amount: $ �a'�
CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION
(All permits must be approved by the On-Site Septic Manager and/or Building Official)
— ---
� Job Sife / Owner lnformation: �� ; �
Site Address: �- �' �S 2-���� �1�!
Owner: S �� �� �/ � ������ Mailing Address: � �`���� ��`'"�`� �"�'
City: �Vzh-�.� Zip:
Home Phone: Alternate Phone:
;x � ra��orJ:Applican� Informa���� ` �������
Contractor/App.: �-�� -� -�s �� �s Contact Person: ����
Address: Z� 3 � � S f � � � State License #: � `f�
City: /���fY�� Zip: S��l �3 Expiration Date: Z � � o
Phone: �-�� , (� !2 - (� ��'- - j�� Altemate Phone�`�� 7�3 -- �7�j �—j�7��
��� � ����� ���p.E"�`��'��� �y� ��.� � ���,� , R��n �� � � �
`F' $ 'q! � �� .i"�„ � _ ���tl Z.����"V��"�Y���.S'3�`�';�db^�'A� 1 �'g�,�'�i.+Sktii�i'''����,s� ,
�] Residential ❑ Commercial ❑ Other
�������,�}s:���"����n�� � �"�,'�:�Ah� {��m�,�x�ar,� . PERMIT TYPE AND FEES
New or Replacement System $100.00
Repair Existing System 50.00 �U
(Tanks or Drainfield)
State Surcharge .50 .50
Total su
� �v -
V:\(Permits)\Septic System Permit Application.doc
1 / 2
,r . 1
` ** ATTENTION APPLICANT *�` - `44*y�' `
s
_ _ Fill in all appropriate bianks and check all appropriate boxes. _
I will be installing the following:
Tanks
❑ Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other
(list manufacturer)
Number of Tanks:
�
Size of Tanks:
Treatment System �����.� .�—
Trenches s•f• �� �'I /1 r��� ��
UC
_� Mound s.f.
� :.__.r.._..�._._---...�.�__......._._____.... �
Gravelless s.f. ��� b-e-� ��� � �-e
Chamber s.f.
Final Cover/ Top Soil
to be borrowed from site (show location on site plan)
�? trucked in
The undersigned hereby applies to the City of Orono for issuance of a septic system
installation permit, agrees to do all the work in strict accordance with ordinances of the City
and regulations of the State of Minnesota and certifies that all statements made on this
application are complete, true and orrect.
---- ----�
Signature of Applicant Date: � ' 7 ' L'��
MPCA License No.: � � �
Staffi Review: �t Accept ❑ Denied
Reviewer: �( �r[� !'�yL-� Date: 7— �� �
Reason for Denial:
Comments (to be printed on inspection card):
�C�!�•-t �A C �tc7 r (_.��) �1� �� 1�[..� l.� (�i�.�) -}t � S .il c-�� S S A r�l.
V:\(Permits)\Septic System Permit Application.doc
2 � 2
C/�� DAT TIME �
CITY OF ORONO CALLED�N /D �
INSPECTION N TICE SCHEDULED �D-,� �:�D
PERMIT NO. � � a- COMPLETED
ADDRESS
OWNER ONTR. ���� ��2�
TELEPHONE NO. la �O�S 4�50
�
� DESCRIPTION ��'�'
� ❑ FOOTING � MECHANICAL RI ❑ EXCAV/GRADING/FILLING
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ IAKESHORENVEfLANDS
''y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE
O ❑ TREE REMOVAL
�Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION
Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT
v ❑ DEMO-FINA� ❑ SEPTIC INSTALL. ❑ FOLLOW-UP
I� ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL
J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
��., COMMENTS:
�
a
g � ��S fifn S j A�.�rGS lQ7� S¢PF�
0
(� �VIJI/ L �� \D �A cJ I 'Tr�IO �AtJ (Ttr�I O
� �-f Sl� (rS . , -,2� r oc� �r 1S / �" r T' Za
y�� Iv�v'!^� .
N�
�
� I�c�� f�oc�L t� � o� �' x ��-�
j ���^�' '
� �WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CA�L FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
iNSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTIONREQUIR�D.CALLTOARRANGEACCESS.
Cal1 for the next inspection 24 hours in advance. (g52) 249-46��
' Owner/Contractor on site:
I� Inspector.�� I < ,
I
� White Copyllnspector's File Canary CopylSite Notice