HomeMy WebLinkAbout2004-P07410 - sewer/water connect ♦ �
PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P07410
Crystal Bay, Minnesota 55323 Pe�mit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued: ai22�2ooa
SITE ADDRESS: 661 Sandstone Cr
I.ong Lake,MN 55356
PID: 33-118-23-11-0035
DESCRI PTION:
Proposed Use: Residenrial
Permit Class: General
Pernut Sub-type(s): Sewer&Water Connections
Permit Type: Sewer and Water Permit
DETAILS:
Approved per resolurion#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 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 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 ITEE SIGNATURE SSUED BY SIGNATURE
Conies: 1-File(SiQnitures Repuired), 1-Atmlicant, 1-Monthlv Reuorts. 1-Assessine. 1-Finance Page 1
(iTpdated 1/5/04)
�IT'�OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
GENERAL INFORMATIO\
1. You may 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 permit card is available on the job site.
5. Utility connection permits may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANl'STREET AND
DO NOT TAP ANY�1AIN 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.
3. All work must be inspected before it is covered. Call(952)249-4600,24 hour notice required.
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JOB SITE ADDRESS: �-� ���P "�� r P
Occupancy Type: Residential Commercial
Owner's Name: �' N 7�?�,��,,« ���� Phone Number:
Mailing Addres�— City: __ Zip:
Contractor's Name: �s �r, � � Phone Number: S� 7.� � �/ S�7
Mailing Address: (�SU( �'D_ r�'� . �� City: �Y/ar� �� � Zip: 5�3���y
PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One)
SAC Charge (2003 rate 51,350.00) $ (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� Schd 40 air tested; cast iron
Municipal Water Connection/Disconnr��pair($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 = 75'
REQUIRED setback from sewer line=20'
PERMIT FEE CALCUL�TION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50 (Minimum)
The State Building Code Division Surcharge of 5.50 per permit 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 Pertnit, agrees to do all work in strict
accordance with the ordinances of the City and the re 1 ' ns of the State of Minnesota, and certifies that all statements
made on this application are complete, true and co ect
Signature of Applicant: Date: ��
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