HomeMy WebLinkAbout2008 - 00393 - sewer connect CITY OF ORONO PERMIT NO.: 2008-00393
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 10/01/2008
r-� (952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2095 WEBBER HILLS RD
PIN : 03-117-23-34-0023
LEGAL DESC : WEBBER HILLS
: LOT 006 BLOCK 003
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : CONNECTION
NOTE: THIS IS THE SAC PAYMENT TO GO WITH PEMIT#2008-00265,IT WASN'T KEYED IN AT THE SAME TIME.
APPLICANT
S.A.C. 1,825.00
SWEEN,THOMAS&DEVIN TOTAL 1,825.00
2095 WEBBER HILLS RD
WAYZATA,MN 55391-
(612)209-7177
OWNER
SWEEN,THOMAS&DEVIN
2095 WEBBER HILLS RD
WAYZATA,MN 55391-
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.
Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
FOR CITY USE ONLY
City of Orono Date Received: Permit#
P.O.Box 66
*, 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
a t, p Crystal Bay,MN 55323
�dd `v� Lf (952)249-4600 Approved By(If Required):
CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT
(*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 That Apply)
❑Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑ Disconnect
Job Site/Owner Information:
Site Address: aD 95 Weeget— )44-eed f
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: Contact Person:
Address: State License#:
City: Zip: Expiration Date:
Phone: Alternate Phone:
:',`':KOC:714 ::C.VIZYlriaaraLj711-MIZTZGZaati;0477 F:50,7373714 1
❑ SAC Charge(2008 Rate=$1,825.00) $ /825.D C)
(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 Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; cast iron
❑ Water Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches;material 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 statements made on this application are,true and correct.
Applicant: Date: