HomeMy WebLinkAbout2006-P10607 (Sewer Disconnect) PERMIT
CITY OF ORONO
2750 Kelle;� Parkway - PO Box 66 Permit Number: p1o607
Crys+al Bay, Minnesota 55323 Permit Type:
Sewer and Water Permit
(952) 249-4600 Date Issued:
11/3 0/2006
SITE ADDRESS: 1404 Baldur Park Rd Unit#
Wayzata, MN 55391
PID: 08-117-23-34-0018
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: Pernut Fee: $ 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Westonka Sewer&Water OWNER: Charles Affias
6501 Co. Rd 15 1404 Baldur Park Rd
Mound,MN 55364 Wayzata MN 55391
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 PL MI EE IGNATURE ED BY SIGNATURE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, l-Assessing,(If Septic, 1-Septic) Page 1
• EOR CITY USE ONLY
��� City of Orono DateReceived: . Permit#
P.O.Box 66
��;; � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
a 'I�V������ � Crystal Bay,MN 55323
�� �' � '`• o~ (952 249-4600 Approved By(If Required):
t,1��4?I���. )
CITY OF ORONO —S�WER & WATER/ GENERAL PERMIT
(*Note:Some permits may require approval by Uie Building Ofticial and/or Public Works Department*)
(ALL PERMiTS- Ntav be subiect to further review and mav not be issued when the ann��cation is received)
GENERAL INFORMATION
1. You may appiy for utility pennits by mail or in person at the City offices.
2. Mailed in applicarions are subject to the postage and handling fee shown below. Pernut cards will
be sent by rehn-n mail�vithin 2 busuiess days.
3. Permits are not valid until you receive a pernut card.
4. Work must not begin unless the peinut card is available on the job site.
5. Utility coiulection permits may be issued to licensed conh-actors only.
6. Contact the Public Works Department(952-249-4600) for utility shtb as-built locations.
DO NOT EXCAVATE II�ANY STREET AND DO NOT TAP ANY MAIN w�ithout express
approval of the Public Works Department. Issuance of a pernut does not grant this approval.
7. All work must be done in accordance with State Code requuements.
8. All work inust be inspected before it is covered. Call(952)249-4600,24+hour notice required.
TYPE OF PERMIT
(Check All That APPIY) '
�,Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Connection ❑Additional Conneerion ❑Re-Connection ❑ Repairs �isconnect
Job Site/ Owner vlformation:
Site Address: � l �� �Cr�V�� ��I r�- ►'ti�
1 �
Owner:l./� «C dM(�� Mailing Address:
City: Zip:
Home Phone: Altemate Phone:
Contractor Information: ��.�� ,���1
� � roJ; f IG � �JQ� � �/�I Pr Contact Person: I �Fr� R l�- ������1 _I
Contractor. � � JP � � `
Address: ���� Cbv'��'� �� 1 G State License#:
City: ���ti�'�� 1���� Zip:"J�3� 1Expiratioi�Date:
Phone: l� �7� " 1 �G� Alternate Phone:
- ' � ` `� DETERIVIINING PERMIT FEES � ` ,� , .
❑ SAC Charge(2005 Rate=�1,550.00) $
(SAC Charge must accompany all sewer pernut applications unless prepaid)
(Orono City Staff can determuie if applicable)
(If not prepaid, a sewer connection permit�vill not be issued)
�Sewer Connection/ isconnect/ epair($35.00/Per Stub) $
Pipe size inc i , Schd 40 air tested; cast iron
❑ VVater Connection/Disconnect/Repair(�35.00/Per Stub) $
Pipe size inches; material Schd 40 air tested; copper
l. SUBTOTAL of Peniut 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 1ViETERS
■ WATER METERS must be picked up and paid for at Orono City Hall, these are on a separate pernut.
■ WATER A�ETERS must be set and sealed by Orono Wate►- Department (952) 249-4600, upon
completion of inetei•installation.
The undersi�med hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do
all work in shict accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies that all stat�lnents made on this application are,true and conect.
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Applicantj� ��� � Date: