HomeMy WebLinkAbout2004-P07812 - sewer/water connect �ITY' OF ORONO PERMIT
2750 Kelley Parkway- PO Box 66 Permit Number: Po�8i2
Crystal Bay, Minnesota 55323 Permit Type: Sewer and water Permit
(952) 249-4600 Date Issued: s�9�2ooa
SITE ADDRESS: 2482 Sandstone La
Long Lake,MN 55356
PID: 33-118-23-11-0025
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Sub-type(s): Sewer&Water Connections
Pernut Type: Sewer and Water Permit
DETAILS:
Approved per resolurion#:
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
THE UNDERSIGNED HEREBY REQUESTS PIItMISSION 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.
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APP CANT PERMITEE SIGNATURE I ED BY SIGNATURE
Conies: 1-File(SiQnitures Reouired), 1-Aunlicant 1-Monthlv Renorts, 1-Assessin�, 1-Finance Page 1
(Updated 1/5/04)
CITY O��ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
GENERAL INFORNIATION
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. Pemut cards will be sent by return 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 coimection 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 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: � r � �.� C-,�l i
Occupancy Type: Residential Commercial
Owner's Name: �� � -r-o �f A�c� I ��< Phone Number:
Mailing Address: City: Zi :
Contractor's Name: @` c,J��t-�-o� � 5�;�) Phone Number: 9�-� y - �! S j
Mailing Address: bs"pc Cp, �`( L� � City: Zip:_ ,i��
PERMIT TYPE �onnections ❑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 Co nection/Disconnect/R pair ($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 2 inches; material l 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 CALCULATION
1. Subtotal of above permit requested $
2. State Surcharee $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per pemut must be
included for each well,sewer and water connection pemut 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 regulations of the State of Minnesota, and certifies that all statements
made on this application are complete, true a c ect.
. . � . �-� � �y
Signature of Applicant. _ Date.
D E TIME "
CITY OF ORONO CALLED IN 8
INSPECTION N TICE SCHEDULED -� -� 'OC�
PERMIT NO. O 7 � � COMPLETED
ADDRESS a T�� ���- �� L�
OWNER CONTR. S
TELEPHONE NO. 9s�- �7 2- ��(��v
� DESCRIPTION ���C � ��� ��•
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Z
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING Rf 23 SEPTIC FINAL 35 HARO COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
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� �ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑CORRECT WORK 8 PROCEED r ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WlLL RETURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours irt advance. �952� 249-46QQ
OwnerlContract site:
Inspector. .
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