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Home My WebLink About2006-P10143 - SAC only » PERMIT C4TY OF ORONO Permit Number: 2750 �ey P.R rkway- PO Box 66 P10143 Crystal ay, IVlinnesota 55323 Permit Type: Sewer and Water Pernut (952)24�-4600 Date Issued: 5/22/2006 SITE ADDRESS: 1245 Sixth Ave N Unit# Long Lake,MN 55356 PID: 26-118-23-34-0007 DESCRIPTION: Proposed Use: Residential Permit Class: General Permit Type: Sewer and Water Permit Permit Sub-type(s): SAC Only DETAILS: Approved per resolution#: Sepazate permits required: NOTICES/REMARKS: SAC Only,Because Missed Keying On Sewer Connection Pemut FEE SUMMARY: valuation: $ 0.00 SAC Fee: $ 1,550.00 TOTAL FEE: $ 1,550.00 APPLICANT: Owner/Self OWNER: Peter Grant MN 1245 Sixth Ave N Long Lake MN 55356 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. APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 a � � � City of Drono P.O. EoM 6b tr932�249-4600MI 55323 07/25f06 l0:40:17 Custorer: P10143 PERMIT5 - 6EI�RRL i e o.oa o.o0 Ease Fee 1 � 0.00 4.00 Plan Review 1 e 0.00 0.OQ Mail in Fees i e o.oa o.o0 State Surcharge i e o.o0 0.o0 5AC Char �e issa.oo isso.o0 Irrvestigation Fee 1 p 0.00 0.00 MIS�D KEYIN6 IN ON S�41ER t�Ml SIIBTDTAL 1,5.50.04 TAX 0.00 TDT�. SALE 1 550.00 Check Received �550.00 (�IAI�E 0.00 CL�It# 02 TRANS# 28548 � � FOR CITY USE ONLY �,�` City of Orono Date Received: Permit# � `v P.O.Box 66 ��; � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed � �'��' ,� Crystal 13ay,MN 55323 � � � `��'E o` (952)249-4600 Approved By(If Required): 1,,rit?;�y �Psxo CITY OF ORONO —SEWER& WATER/ GENERAL PERMIT (*Note:Some permits inay require approval by the Building Official and/or Public Works Department*) (A1 I PFIiMITS Nlav he subiect to further review and mav not be issued when the application is received) GENERAL INFORMATION 1. You may apply for utility pennits by mail or in person at the City offices. 2. Mailed in applications are subject to the postage and handling fee shown below. Perniit cards will be sent by retuin 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 connection permits may be issued to licensed conh-actors only. 6. Contact the Public Works Department(952-249-4600)for utility shib as-built locations. DO NOT EXCAVATE IN ANY STRF.:ET AND DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a perniit 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 OF PERMIT (Check All That Apply) ❑ Residential(May Require Approval) ❑ Conunercial(Approval Required) Q �}._/ ❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect �i ,r V t,�t J (Y\J Job Site/ Owner Information: �� `\ -, _ \ � , ,,_ -� ;-� i ,k �+— t.. � I ( �- � Site Address: � � ` �� 1 ` � - `—� ,�(� ; , ,�1� ;� � � `.fi��lin Address: °� ��}� Owner: �� ., ` 1 � � �� ' .�: _. � � g �� . " 1\ city: �� zip: �N , -'--- � Home Phone: '�' �' �� Alternate Phone: Contractor Information: �� Contractor: Contact Person: 1�,� � Address: State License #: City: Zip: Expiration Date: Phone: Alternate Phone: y � � DETERIVIINING PERMIT FEES . ) � � �: ❑ SAC Charge(2005 Rate�$1,550.00) � $ l � � � � (SAC Charge must accompaiiy"all sewer pernut applications unless prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permit will not be issued) ❑ Sewer Connection/Disconnect/Repair($35.00/Per Stub) $ Pipe size 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 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 METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate pernut. ■ 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 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,true and correct. Applicant: Date: