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HomeMy WebLinkAbout2007-P11539 - sewer/water connect PERMIT CITY OP ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: P11539 Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit x;952) 249-4600 Date Issued: 10/5/2007 SITE ADDRESS: 2709 Walters Port La Unit# Excelsior,MN 55331 PID: 21-117-23-23-0045 DESCRIPTION: Proposed Use: Residential Permit Class: General Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer&Water Connections DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: SAC Grandfathered In#686- 11/13/1964 FEE SUMMARY: Permit Fee: $ 70.00 Valuation: $ 0.00 State Surcharge Fee: $ 0.50 TOTAL FEE: $ 70.50 APPLICANT: Westonka Sewer&Water OWNER: William&Susan Dunkely 6501 Co.Rd 15 2709 Walters Port La Mound,MN 55364 Exclesior MN 55331 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 RE UIREMENTS. APP PERMIT SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 c a City of Orono P.DO. Box 666, (952)249-46003 02/04/08 15:55:39 Customer: P11714 P11721 PERMITS -1�� 0.00 0.00 Base Fee 1 @ 103.25 103.25 Plan RevI @ 0.00 0.00 Mail in es ie@ 0.00 0.00 State Surcharge 1 @ 1.90 1.90 SAC Char?e,� @ o.ao 0.00 Investigation Fee 1 @ 103.25 103.25 PERMITS - GEMERAL 1 0.00 0.00 Base Fee 1 @ 103.25 103.25 Plan RevI @ 0.00 0.00 Mail in Fees I @ 0.00 0.00 State Sul Barge 1.90 1.90 SAC e Chargg 1 @ 0.00 0.00 Investigation Fee 1 @ 103.25 103.25 SUBTOTAL 416.80 TAX 0.00 TOTAL SALE 416.80 Check Received 416.80 ofm 0.00 CLERK# 04 TRANS# 32310 • FOR CITY USE•ONUY 0A ♦ '1041 City of Orono Date:Received: Permit# © P.O.Box 66 % 2750 Kelley Parkway O.Ip=/louse St1CDetermrnationTvrm Completed Crystal Bay,MN 55323 (952)2494600 Approved By(JfhLequired): CITY OF ORONO—SEWER& WATER/GENERAL PERMIT � ' UA (*Note:Some permits may require approval by the Building Official and/or Public Works Department') (ALL PERMITS- May be subject to further review and may not be issued when the application is received) GENERAL INFORMATION. 1. You may apply for utility permits 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 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 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. TYPE OF PERMIT Check All,T Apply) Residential(May Require Approval) ❑ Commercial(Approval Required) F2 New Connection ❑Additional Connection ❑Re-Connection ®Repairs ❑Disconnect Job'Site/Owner Information; Site Address: 2 705 �)c, j�Sry f Owner: Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: L^)e3t)-4 Kg ��C-J Contact Person: Edc�•1 Address: Ii__D( CD. /1d /5 State License City: V40r-c'4 Zip:13S34 (Expiration Date: Phone: 6�;� f q72-V966 Alternate Phone: ❑SAC Charge(2007 Rate=$1,675.00) $ (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) ®Sewer Conne ion/Disconnect/R\ep/air($35.00/Per Stub) $ Pipe size L inches;material `Schd 40 air tested; 0 cast iron ❑Water Connection/Disconnect/Repair($35.00/Per Stub $ Pipe size � inches;material_Y__ 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 permit. ■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, 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 stateme made this application are,true and correct. Applicant: Date: l�"1 �