HomeMy WebLinkAbout2004-P07754 - sewer connect . +•�-
ITY F RON PERMIT
�' � � � Permit Number:
2750 Kelley Parkway- PO Box 66 Po��sa
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: �i2�i2ooa
SITE ADDRESS: 2100 Sixth Ave N
I.ong Lake,MN 55356
P I D: 27-118-23-31-0024
DESCRIPTION:
Proposed Use: Residenrial
Permit Class: General
Permit Type: Sewer and Water Pernrit Permit Sub-type(s): Sewer Connecrion
DETAILS:
Approved per resolurion#:
Separate permits required:
NOTICES/REMARKS: �
FEE SUMMARY: Permit Fee: $ 35.00 Valuation• $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: VOLKENANT INC OWNER: orono woodland Inc
1030 CO RD 83 2100 Sixth Ave N
MAPLE PLAIN,MN 55359 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.
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APPLICANT PERMITEE SIGNATURE ISSUED BY SI ATURE
Couies: 1-File(SiQnitures Required), 1-Auplicant 1-Monthlv Reuorts, 1-Assessin�, 1-Finance Page 1
. -. �
(Updated 1/5/04)
CITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER& 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 shown below. Pernut 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 pernut card is available on the job site.
5. Utility comiection pernuts may be issued to licensed contractors only.
6. Contact tl�e Public Works Deparnnent(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN AN1'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: �I G� L��� � ✓� ./�
Occupancy Type: Reside tial Commercial
Owner's Name: � /Ztr�t� (,(�p��� �a,��S Phone Number: `�5 z y 7 3 db�� 2-
Mailing Add►•ess: 2 t ao �-tk � �7 . City: �;,,1,;�� Zip: S5 3 5�
Contractor's Name: �p Lv �- e- Phone Number: `71a � �r�� ,,s�7
Mailing Address: o �, � /�� . „.i City: 1� � Zip: S� ��s��
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/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.
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 Surchar�e $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per pernut must be
included for each well,sewer and water connection pernut requested.
3. Postage & 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 omplete, true and correct.
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Signature of Applicant: >�c� � '��-�---�— Date: �- Z -7`�`�