HomeMy WebLinkAbout2004-P07268 - sewer/water connect �` PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 P07268
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: 2i2�i2ooa
SITE ADDRESS: 2462 Sandstone La
L.ong Lake,MN 55356
PID: 33-118-23-11-0028
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' Westonka Water&Sewer OWNER' Dahlstrom Development LLC
� 6501 County Rd 15 � 7745 Polaris Lane
Mound,MN 55364 Maple Grove,MN 55311
TT-�E UNDERSIGNID HIItEBY 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 UIREIvIII�iTS.
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APPLICANT PERMTfEE SIGNATURE ISSUED BY SIGNATURE
Conies: 1-File(Sixnitures Requiredl. 1-Annlicant, 1-Monthlv Renorts. 1-Assessine, 1-Finance Page 1
(Updated 1/5/04)
CITY 0�;� ORONO APPLICATION FOR UTILITY PERI�IITS
Bo�66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
GENERAL INFORMATION
1. You may apply for utility permits 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 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 locations. DO NOT EXCAVATE IN ANY STREET AND
DO NOT TAP ANY MAIN w7thout express approval of the Public Works Deparnnent. 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: ��b� �`������P �✓"�
Occupancy Type: Residential Commercial
Owner's Name: � — � G,., > �; - Phone Number:
Mailing Address: City: Zi :
Contractor's Name: ,„���� � �> Phone Number. -
NTailing Address:_��'�� cx�� �2c(, �s City:�'"�E�� Zip:_'�-�,��
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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)
Municipal Sewer onnection/Disconnect/ epair ($35.00 per stub) $
pipe size�inches; material�Schd 40 air tested; cast iron
Municipal Water Connection/Disconnect/ epair ($35.00 per stub) $
pipe size / 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
(9�2-249-4600) upon completion of ineter installation.
REQUIRED minimum setbacks from drain field and septic tanks = 75'
REQUIRED setback from sewer line=20'
PERI�IIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50 (Minimum)
The State Building Code Di�-ision Surcharge of$.50 per pernut must be
included for each well,sewer and water connection 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 are complete, true correct.
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Signature of Applicant: Date: � � � �