HomeMy WebLinkAbout2017-01329 - sewer reconnect CITY OF ORONO * 2 0 1 7 — 0 1 3 2 9
2750 KELLEY PARKWAY DATE ISSUED: 10/16/2017
ORONO,MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 780 TONKAWA RD
PIN : 05-117-23-34-0010
LEGAL DESC : PARTENS POINT 1 ST DIV
: LOT 015 BLOCK 000
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : RE-CONNECT
NOTE: RE-CONNECT SEWER
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
STATE SURCHARGE SEWER&WATER 1.00
D.S.M.EXCAVATING TOTAL 51.00
2916 ENTERPRISE AVE Payment(s)
HASTINGS,MN 55033- CREDIT CARD 5166 51.00
(651)480-1355
OWNER
MENZEL,KEITH
780 TONKAWA RD
LONG LAKE,MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause
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CITY OF ORONO-SEWER&WATER/GENERAL PERMIT
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GENERAL WFORMAnON
I. You may apply for utility permits by mail or m 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 within 2 business days.
3. Permits are not valid until.you receive a permit earl.
4. Work must not begin unless the permit card is available on the job site.
5. Utility connection 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 permit 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,
'l'WE OF PERW
Cheek All That Apply)
TfResidential(May Require Approval) ❑Commercial(Approval Required)
ox*w�eti®n ❑Additional Connection ZRe-Conn�ec;tio�2n ❑Repairs ❑Disconnect
❑ Water Availability Conn ok-Up to Water
Job She/Owner Wormation:
Site Address: 780 72WeoAih9
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information.-
Contractor:
nformation:Contractor: S,/jI, &k49?*,v4 IW4 Contact Person:
Address: 2,?4 S A• State License M
City: •NQS Zip:$Z?3 Expiration Date:
Phone: �rS'� yBQ./3S5" Alternate Phone:
a _
buMMORLO PE
❑SAC Charge(2015 Rate=$2,485.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
Sewe Connection Disconnect/Repair($50.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; cast iron
isconnect/Repair($50.00/Per Stub) $
Pipe size�inches;material Schd 40 air tested; copper
❑Water Availability For Future Hook-Up to Water($50.00) $
Water Availability Explanation:
Contractor installed line to inside of house for future hook-up.
This line will be inspected by the Public Works Department.
Required Before Water Connection Permit is Issued:
1. Issue Water Meter&Horn Permit
2. Any Additional Connection Fees Paid(If Applicable)
Issue Water Connection Permit:
1. Collect Permit Fee&Issue Water Connection Permit
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ 1.00
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
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 pggt-
• WATER METERS must be set and sealed by Orono Water Department (952) 2494600, upon
completion of meter 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: