HomeMy WebLinkAbout2004-P07259 - sewer/water connect ` � PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Po�2s9
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: 2i2sizooa
SITE ADDRESS: 2476 Sandstone La
L.ong I.alce,NIN 55356
PID: 33-118-23-11-0026
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: $ ��•� 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 UNDERSIGNID HII2EBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN Sf RICT COMPL,IANCE WITH ALL CTTY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUII.DING CODE REQUII2EMII�iTS.
C
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APPLICANTPERMITEES NATURE ISSUEDBYSIGNATURE
Copies: 1-File(SiQnitures Reauiredl. 1-Annlicant, 1-Monthlv Renorts. 1-Assessine. 1-Finance Page 1
(ilpdated 1/5/04)
CI+�Y OF ORONO APPLICATION FOR UTILITY PERl�IITS
Box 66 (2750 Kelley Parkway) SEWER/`�:-�TER& 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 showv below. Permit cards�izll be sent by ret�n mail the same day
the application 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 locarions. DO NOT EXCAVATE Iti�`�TY 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)249-4600,2�3 hour notice required.
JOB SITE ADDRESS: �7 7� S� ��?�/�•����� �J�
Occupancy Type: � Residential Commercial
Owner's Name:__ �� ��y�,��� /�,�� �S Phone\umber:
Mailing Address: City: _ Zip:
Contractor's Name: �� �� � Phone\umber: v�7.-� �- " 6 6
Nlailing Address: �;�S6f c� , , �S- City:__;���.� �J Zip: 5-�-3��'
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 Connection/Disconnect/Repair ($35.00 per stub) $
pipe size�inches; material� Schd 40 air tested; cast iron
Municipal Water Connection/Disconnect/Repair($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
(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
l. Subtotal of above permit requested $
2. State Surchar�e $ .50 (vlinimum)
The State Building Code Division Surcharge of$.50 per permit must be
included for each well,sewer and water connection permit requested.
3. Posta�e &Handling (Only mail-in applications) $ 1.50 (Llail 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 Pernut, 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 co ct.
Signature of Applicant: Date: 2� �
✓
DATE TIME
CITY OF ORONO CALIED IN Z-2���
INSPECTION NOTICE SCHEDULED J�� '�.
PERMIT NO. �C�72`� COMPLETED � �
ADDRESS_ o� ��[� S C�CQ �"�Y�2.
OWNER CONTR. f,�S'�s�C'�-S��
TELEPHONE N0. ��2 �7? L I�'.S-�l
� DESCRIPTION
� 01 FOOTING t i MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WEfLANDS
y 03 INSULATION 24/25 WOOD ER/FIREPLACE 34 TREE REMOVAL
Z � W�B�• WATER HOOK-UP 17 SITE INSPECTION
Q OS fINAL 14 SEW HOOK-U O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-fINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FI 35 HARO COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
� OWNERICONTRACTOR TO MEET YOU: ES_NO
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W RK SATISFACTORY:PROCEED ❑PROJECT COMPLETE
❑CORRECT WORK 8 PROCEED ❑ISSUE CEFiTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
O CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDEH POSTED.CALL INSPECTOR
�CITATION ISSUED
�INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
OwnerlContracto ' e:
Inspecto
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