HomeMy WebLinkAbout2003-P06574 - sewer/water disconnect CITY OF ORONO PERMIT
�75�`�:elley Parkway - PO Box 66 Permit Number: Po6s�4
C;rystal Bay, Minnesota 55323 Pe►-mit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: �i22i2oo3
SITE ADDRESS: 1300 Spruce Pl
MOLJND,MN 55364
PID: 08-117-23-32-0016
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer Disconnect
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 35.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: �'�'ickenhauser Exc. Inc. OWNER: Killian's Gate LLC(Dr.Dennis Killian)
350 Villa Drive 1300 Spruce Pl
Cologne,MN 55322 Mound,MN 55364
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE S[GNATURE ISSUED BY SIGNATURE
Covies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reoorts, 1-Assessine, 1-Finance Page 1
(ilpdated 6/2/03)
CITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
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GENEIfAL INFORMATION
1. You may apply for utility permits by mail or in person at the City offices.
2. Mailed in applicarions are subject to the postage and handling fee shown below. Permit cards will be sent by return mail the same day
the applicarion 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 connection pemuts may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600)for utility stub as-built locarions. DO NOT EXCAVATE IN ANY STREET AND
DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a permit does not gzant 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: 3 �� � � ��C /�� �'
Occupancy Type: Residential Commercial
Owner's Name: r ��-�s''S n � Phone Number: ��'�-� ���''�a � �
Mailing Address: oZ�/' ¢ � City: l��a y z��U Zip: ,5S3p,f
Contractor's Name: �G � c.cs-Pr �'-� Phone Number: 9s�� YG�--S'�S�3
Mailing Address: 3 �d � d City: :� o ��� Zip: _5'S'3 z2
PERl�'iIT TYPE ❑Connections ❑Repairs �isconnect (Check One)
� SAC Charge (2003 rate$1,275.00) $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Connectio ' conne /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.
REQUl RED 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 permit 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 state�n�nts
made on this application e complete, true and c ect.
.
Signature of Applicant: �--- `� Date: �^ ��--_ n3