HomeMy WebLinkAbout2004-P07414 - sewer/water connect 4 r � PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: Po�aia
Crystal Bay, Minnesota 55323 Pe►'mit Type: Sewer and water Pernut
(952) 249-4600 Date Issued: 4/22/2004
SITE ADDRESS: 651 Sandstone Cr
Long Lake,MN 55356
PID: 33-118-23-11-0030
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Pernut Pernut Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#: �
Separate perxnits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 70.00 Valuation• $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Westonka Water&Sewer OWNER: Dahlstrom Development LLC
6501 County Rd 15 7745 Polaris Lane
Mound,MN 55364 Maple Grove,MN 55311
THE 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.
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APPLICA E SIGNATURE ISSUED BY SIGNATURE
Conies: 1-File(SiQnitures Reauired), 1-Anulicant 1-Monthlv Reuorts, 1-Assessin¢, 1-Finance Page 1
(tipdated 1/5/04)
CITY OF ORONO APPLICATION FOR UTILITY PER�r1ITS
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay,MN 55323
GENERAL INFORMATION
1. You may apply for utility pernuts by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Permit 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 connection pemuts may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600)for utility stub as-built locarions. DO NOT EXCA�:�TE L`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(952)249-4600,24 hour notice required.
JOB SITE ADDRESS: ��j c.�c� �: G. ,�
Occupancy Type: Residential Commercial
Owner's Name: ���n le.:�.��� /��-;;��� Phone Number:
nlailing Address: City: Zip:
Contractor's Name:�����f,�, �; �/6_� Phone Number:� g�a � y��-yq3��
�Iailing Address:�-;�! ��, ,��iS— City: �d„� Zip: S'S���/
PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One)
SAC Charge (2003 rate $1,350.00) $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Nlunicipal Sewer Connection/Disconnect/Repair ($35.00 per stub) $
pipe size�inches; material ��� Schd 40 air tested; cast iron
1�Iunicipal Water Connection/Disconnect/Repair ($35.00 per stub) $
pipe size�_inches; material� copper; other
`VATER METERS must be picked up and paid for at City Hall.
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 Surchar�e $ .50 (11�finimum)
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 (l�iail 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 are complete, true and ct.
Signature of Applicant: � Date: `1 ��10�
� a� TIME
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CITY OF ORONO CALLED IN LY
INSPECTION TICE SCHEDULED - �� �
PERMIT N0. ��� COMPLETED
ADDRESS � S
OWNER CONTR. l,(�PS Q>
TELEPHONE NO. '�a'"��
� DESCRIPTION ����- � LC�Q�-2�C ��C�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WA�L BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
v�i COMMENTS:
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W� WORKSATISFACTORY:PROCEED PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
�STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
�INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. (952) 249-46�0
Owner/Contr n site:
Inspector.
White Copyllnspector's File Canary CopylSite Notice