HomeMy WebLinkAbout2006-P09603 - sewer/water connect PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 Po96o3
Crystal Ba�� Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 2�9-4�ei('�0 Date Issued: 2/14/2006
SITE ADDRESS: 2538 Sandstone La Unit#
Long Lake,MN 55356
PID: 33-118-23-11-0017
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:
SAC Paid#P09570- 12/13/06
FEE SUMMARY: Permit Fee: $ 70.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Groth Water& Sewer OWNER: ZB Construction,Inc.
775 Tower Drive 10300 l Oth Ave.N.
Hamel,MN 55340 Plymouth, MN 55441
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.
l� =2-�� , � I�--�_ ' s� ` �; 'ti� �,� �,y�
.,.
�
APPL CANT PGRMITEE SIGNATUR ISSUED SIGNATURE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
FOR CITY USE ONLY
�, ,¢�� Clty Of OCOno Date Received: Permit#
P.O.Box 66 �C)�
�' �,'` � 2750 Kellcy Parkway ❑In-House SAC Determination Form Completed �, �J '��
k•R�.'.�tfY
`i ?
a �j�•ch,ar�-. � Crystal Bay,MN 55323 � � � ��
��t��r�i,��"�°� (952)249-4600 Approved By(If Required): �L
�Raexoa
CITY OF ORONO —SEWER& WATER/ GENERAL PERMIT
(*Note:Some permits may require approval Uy the Building Official and/or Public Works Department*)
(ALL PERMITS- Mav be subiect to further review and mav not be issued when the apnlication is received)
GENERAL INFORMATION �
1. You may apply for utility peimits by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Peimit cards will
be sent by return mail within 2 business days.
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 comiection 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 ANY STREET AND DO NOT TAP ANY MAIN without express
approval of the Public Works Department. Issuance of a pern�it 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.
� TYPE O�' PERMIT
(Check All That Apply)
❑ Residential(May Require Approval) ❑ Commercial(Approval Required)
� New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect
Job Site/ Owner Information:
Site Address: � � 5�5 � �� d"����� �'� � /!J
Owner: � ���;� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
� �
,�/��; --� �/ �
Contractor: � ���►D�I S 2�C-c-� Contact Person: � ��� %�- ���
��
Address: 7� s �CC`�������� State License #: 5���
Cit �
y: ����f�-�-� ,��/2)Zip c3-� L�xpiration Date: � � 3� L� C�
Phone:�( j y7r� � %/� Alternate Phone: 4�' 1,.L �/f> L7 � y '>
�: ,
� ; � .�t, r r s Dfi'T:�RiV�G`PE�T�F��S ,.��'A' �: � �a ..�;
�
❑SAC Charge(2005 Rate=$1,450.00) $
(SAC Charge must accompany all sewer pernut applications unless prepaid)
(Orono City Staff can deternune if applicable)
(If not prepaid,a sewer connection permit will not be issued)
�Sewer Con�f tion/Disconnect/Repair($35.00/Per Stub) $
Pipe size "1 inches;material Schd 40 air tested; cast iron
�/�-� �
[�Water Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size�inches;material Schd 40 air tested; copper
c�
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
ADDITIONAL INFORMATION-WATER NIETERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of ineter installation.
The undersigned hereby applies to the City of Orono for issuance of a Urility 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,true and correct.
Applicant: � Date: � l �-� �' �•
� .