HomeMy WebLinkAbout2004-P07214 - sewer/water connect CITY Q� ORONO PERMIT
2750 Kelle�� P�:rkway - PO Box 66 Permit Number: Po�2i4
Crystal Bay. iV`iinnesota 55323 P2Cllllt Type: Sewer and Water Permit
(952) 249`4600 Date Issued: 2i9i2ooa
SITE ADDRESS: 653 Sandstone Cr
Long Lake,MN 55356
PID: 33-118-23-11-9928
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Sub-type(s): Sewer&Water Connections
Permit Type: Sewer and Water Permit
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: PermitFee: $ 70.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: �'�'estonka Water&Sewer OWNER: Dahlstrom Development LLC
6501 County Rd 15 7745 Polaris Lane
Mound,MN 55364 Maple Grove,MN 55311
THE UNDERSIGNED HERFBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND SI'ATE OF
MINNESOTA BUII,DING CODE REQUIl2F_.MENTS.
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APPLICANT MITEE SIGNATURE ISSUED SIGNATURE
Coaies: 1-File(Siefaitures Renuiredl, 1-Apolican� 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
(Updated 1/5/04)
CITY OF ORONO APPLICATION FOR UTILI'T�i'PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, ? v 55323
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GENERAL INk'ORMATION
1. You inay apply for utility permits by mail or in person at the City offices.
2. Mailed in applicarions are subject to the postage and handling fee shown below. Permit cards will be sent by retum 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 pernut card is available on the job site.
5. Utility connection pernuts may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600)for utility stub as-built locarions. DO\OT EXCAVATE IN ANY STREET:�.�ID
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.
8. All work must be inspected before it is covered. Call(952)249-4600,24 hour notice required.
JOB SITE ADDRESS: C�3 �-�i ►'��"��Oo�t� �%/�
Occupancy Type: ���Residential Commercial
Owner's Name: Phone Number:
Mailing Address: City: Zip:
Contractor's Name: •� -� `7 . � ' � Phone Number: S - �
Mailing Address: , �� • Cit3': �, Zip: ��:36/
PERMIT TYPE �'Connections ❑Repairs ❑Disconnect (Check One)
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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)
Municipal Sewer Connection/Disconnect/Repair($35.00 per stub) $
pipe size�inches; material���chd 40 air tested; cast iron
7�—
Municipal Water Co�nection/Disconnect/Repair ($35.00 per stub) $
pipe size '� inches; material�-copper; other
WATER 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= 7�'
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 permit must be
included for each well,sewer and water connection permit requested.
3. Postage & 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 UtilityF Permit, agrees to do all work in strict
accordance with the ordinances of the City and the regulatio f the State of�linnesota, and certifies that all statements
made on this application are complete, true and correc
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Signature of Applicant: �-�'� Date: ���--���