HomeMy WebLinkAbout2004-P07213 - sewer/water connect CITY OF ORONO PERMIT
Permit Number:
2750 Kell*Parkway - PO Box 66 P07213
Cryst.4! 8ay, Minnesota 55323 PeCC111t Type: Sewer and Water Permit
(952) 249-4600 Date Issued: 2i�i2oo4
SITE ADDRESS: 246o Sandstone La
Long Lake,MN 55356
PID: 33-118-23-11-9926
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit 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
1T�i.JNDERSIGNID Ifr:RF.BY 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 REQUIRF.NIENTS.
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APPUCANT VERMITEE SIGh1ATURE ISSUED BY SIGNATURE
Covies: 1-File(SiQ�iitures Reauirecl), 1-Avolicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
(LJpdated 1/5/04)
CITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
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GENER;�L INFORMATIO�I
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. Pernut 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 pernuts 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 ANY STREET AND
DO NOT TAP ANY ti1AIN without express approval of the Public Works Department. Issuance of a pemut 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: ��I{,L7 ��-���� ����1�' G..�t.%•
Occupancy Type: �'� Residential Commercial
Owner's Name: - Phone Number:
1�Iailing Address: City: Zip:
Contractor's Name: b,���,,�,,�5 5;�,,,,.� Phone Numbe ; �� �1 �J 7_> _ y�E�
Nlailing Address: __L��/ �'v. ��. �; City:��,,,,,���/ Zip: SS�,� �
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 �r inches; material �Schd 40 air tested; cast iron
Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $
pipe size ` r inches; material�copper; other
WATER METERS must be picked up and paid for at City Hall.
�Vater 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'
REQUIlZED setback from sewer line=20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per perniit must be
included for each well,sewer and water connection pernut requested.
3. Posta�e & Handling (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 re ulations of the State of Minnesota, and certifies that all statements
made on this application are complete, true a t.
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Si�ature of Applicant: Date: - `C�