HomeMy WebLinkAbout2004-P07882 - SAC only " �� PERMIT
CITY-+OF.ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P07882
Crystal Bay, Minnesota 55323 Pe�mit Type: Sewer and water Permit
(952) 249-4600 Date Issued: 8/25/2004
SITE ADDRESS: 2135 Sixth Ave N
L.ong Lake,MN 55356
P I D: 27-118-23-31-0005
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): SAC Only
DETAILS:
Approved per resolurion#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Valuation: $ 0.00
SAC Fee: $ 1,350.00
TOTAL FEE: $ 1,350.00
APPLICANT: �chard&Sally Valiton OWNER' �chard&Sally Valiton
2135 Sixth Ave N � 2135 Sixth Ave N
Long Lake MN 55356 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 ERMITEE SIGNATURE ISSUED BY SIGNATURE
Couies: 1-File(SiQnitures Required), 1-Avnlicant, 1-Monthlv Renorts. 1-Assessine, 1-Finance Page 1
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(Updated 1/5/04)
CITY OF �RONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
GENERAL INFORNLATION
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. Permit 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 the Public Works Deparhneut(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND
DO NOT TAP ANY MAIN�vithout express approval of the Public Works Department. Issuance of a pemut 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: a���� CC� t�- �� V�
Occupancy Type: �Residential Commercial
Owner's Name:��.G�c�.�c�.+ SP�`.�..� �RL+��� Phone Number: 9So'� —��3--%�4 /
Mailing Address:a/�, -�,_('o ;��, � City: ;��.� �c:�- Zip: 5S3.S'.�
Contractor's Name: k,m�1r�R�1c�,� Phone Number:
Mailiug Address: City: Zip:
PERMIT TYPE �Coimections ❑Repairs ❑Disconnect (Check One)
SAC Char (2003 rate $1,350.00) $ � 3 ��` w (Set Rate)
arge 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.
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 permit must be
included for each well,sewer and water connection pernnt requested.
3. Postage & Handlin� (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 and correct.
Signature of Applicant: SG� Date: — � C'