HomeMy WebLinkAbout2003-P06973 - SAC only ' `` PERMIT
CITY OF ORONO permit Number:
2750 Kelley Parkway- PO Box 66 P06973
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued: 11�3�2003
SITE ADDRESS: 250 Ruann Rd
Wayzata,MN 55391
PID: 36-118-23-32-0002
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Pernut Type: Sewer and Water Permit Permit Sub-type(s): SAC Only
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: valuation: $ o.00
SAC Fee: $ 1,275.00
TOTAL FEE: $ 1,275.00
APPLICANT: owner/Self OWNER: Paul&Kay Studebaker
M� 250 Ruann Rd.
Wayzata,MN 55391
Tf�UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
APPLICANT PERMITEE SIGNATURE D BY SIGN
Conies: 1-File(SiQnitures Required), 1-At�alicant 1-Monthlv Renorts, 1-AssessinQ. 1-Finar►ce Page 1
(IJpdated 6/2/03)
CIT�Y OF:�RONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay,MN 55323
GENERAL INFOR�TION
1. You may apply for urility pernrits by mail or in person at the City offices.
2. Mailed in applicarions are subject to the postage and handling fee shown below. Pemut cards will be sent by return mail the same day ;;�
the applicarion 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 connecrion pernuts may be issued to licensed contractors only.
6. Contact the Public Warks Department(952-249-4600)for utility stub as-built locarions. DO NOT EXCAVATE IN ANY STREET AND
DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a pernut does not grant this approval. '
7. All work must be done in accordance with State Code requirements. �'s'
8. All work must be inspected before it is covered. Call(952)249-4600,24 hour notice required.
JOB SITE ADDRESS: � � G' ��u �� �C
Occupancy Type• Residential Commercial
Owner's Namec �'- Phone Number• ��Z y7� Z Z�--)
Mailing Address: ' City: �G cI� ` Zip: �?r)
Contractor's Name: Phone Number:
Mailing Address: City: Zip:
PERMIT TYPE ❑Connections ❑Repairs ❑Disconnect (Check One)
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SAC Charge (2003 rate $1,275.00) �'� �'" ���'��� $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Connection/Disconnect/Repair ($35.00 per stub) $
pipe size inches; material Schd 40 air tested; cast iron
Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $
pipe size inches; material copper; other
WATER METERS must be picked up and paid for at City Ha1L
Water meters must be set and sealed by Orono Water Department
(952-249-4600) upon completion of ineter installation.
REQUIRED minimum setbacks from drain field and septic tanks = 75'
REQUIRED setback from sewer line=20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surcharae $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per pemut must be
included for each well,sewer and water connecrion permit requested. �
3. Posta�e & Handlin� (Only mail-in applications) $ 1.50 (Mail In Only)
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 e c mple , e d correcX.
;' �;
Signature of Applican�• - Date: ��✓�"/�J
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