HomeMy WebLinkAbout1984-7622 (Well) GENERAL PERMIT CITYPERMITNO. "�622 �
CITY OF ORONO _
P.O.BOX 66 Date +�
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner � ��� /�-l._� / �`7` � - �(1:�� �
Address
Contractor �_�C�tJ-�f")S 11�! Address � � — � l�
City License No. � /� � State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: �NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing (#fixtures_) Fee $ Water Well Fee $�_�'-'�..5��
Water Meter (Size) Fee � Mechanical Equipment Fee $
Meter#
Remote# Moving /Lifting Buildings Fee $
Municipal Water Connection Fee $ Land Alteration (Excavation, Fee $
� Grading, Filling, etc.)
❑Copper
Municipal Sewer Connection Fee $ _ _
Fire Fee $
❑ PVC ❑Cast n Sprinkler System (Fire) Fee $
MWCC SAC Charge Fee $ Other: Fee $
On Site Septic System Fee $ After-the-fact Investigation Fee $ � • ��
ACKNOWLEDGEMENT TOTAL
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information, �
terms, conditions or requirements written above. The
undersigned understands and a�ees under penalty of law State Surcharge: Fee $
that this permit is strictly limited in scope to the work, . �
activity or irnprovement specified; that this perxnit does
not grant any authority to do work or activities requiring Total Amount Paid to City Fee $
sepazate permit approvals; and that this permit does not
grant authority to violate any provision of any City
ordinance or State law,rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
codes �a�or health department regulations, �a sheu be This permit is not valid until the proper fee is paid and
subiect to inspection, approval or reiection by the c�cY. it is approved by an authorized City Official.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
.
Signature of Appl�a � , Si t re of City Offi ' �
/ ���, �.-�.d,� �
Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt
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�- Y� CITY of OR(���
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7 Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
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• On the North Shore of Lake Minnetonka
• - • •
September 19 , 1984
Stevens Well
6240 Highway 12
Maple Plain, MN 55359
Gentlemen :
I appreciate your prompt submittal of state well records as you drill
wells in Orono. These records are valuable to the City and the
homeowner, and in the long run will aid in maintaining the groundwater
quality.
However, you have sent me one for which I have no permit on file, namely
Gordon Tanke at 1440 Baldur Park Road. Please submit the permit fee of
$30 . 50 and the after-the-fact fee of $30 . 00 , totaling $60 . 50 with the
attached permit application, and we will mail out the permit.
Thank you.
Sincerely,
�' . �-��—�-:.
�—`
Michael P. Ga f on
Building & Zoning Department
ps
Enclosure
BUILUING& 'LONING - 473•7357 • ADMINISTRATION& FINANCE -473-7358 • PUBLIC 1ti'ORKS - 473-7359
ASStSSIN G
Applicat�on �or
�_i���' O� ����►�)'i�� Utnlit� F'era�ti�s
��:vE�,L ztv�c�P.t+�ATzotv sevwer water we11
1. Vou �nay apPlN 6ma uttL�ty penmite bu maiP ox 4n pelean at the City o5�<cea.
2. uailcd in appl4c.aLione arte eubjeci to the poetaqe and handCing 6eee ahown beCow. Pertm4t cande wi11 be eeni bu
neturtn maiP ihe ea�ne day ihe appCication ta �eeceived.
3. PERH7TS ARE N07 VALID UNi'TL YOU RECEIUE A FfRMIi CARD.
4. 4�ORK MUST NOT BEGIN UNLESS THE PfRHIT CARP IS AVAiLABIf ON 7HE JOB S1TE.
5. uitftiy conneciion pertmite may be teaued to C(ceneed cenf�eaciorte enP�r.
6. Cnnfact the C4:iy o561cee �oa uLiLity etub aa-bu(£t [ocatlone.
DC NOT FXl'AVA7E 1N ANV S7REET AND DO NOT 7AP ANY IIAIN withnut expneee appnevcl o� the Vublic Woake Uepaatment.
ISSUANCE OF A �ERIUI' DOfS NOT GRAN7 7NIS APPROVAL.
7. ALL wORK MUS7 8E ?'ONE IN ACCORDA�;CE tU17H S7ATE CODE REQUIFEAIEN7S.
a. AL[ wnak muet be �nepecZed be6oae ii ie caveRed. CaIL 173-1357.
To aeau2e p-�nmp.t inepect<on, net<pu ti�e tnepectort beboae woak b�441E.
I N S T;�Ul:,2'I UN� Complete aLC �teme on titie appltcaiion. Compute the pertmit bee. Stgn and date the celi<�{icatian.
� � T!aC011PLE7E APPLiCA7I0NS W1CL NCT SE PROCESSED. Ib you have �ueetiona, caPf 473-735%.
G1ALK- IN P�Rh4I7S At��p�y a� C��y CU�.�.ce�5 , 1335 Sou.tl� 8n.aw� Raad ( C��. Rd. 146 )
MAIL-IN P�Rh1ITS �ne�o.5e �ee - ti�a��. �:o = P. O . }3ax 6G , Cn��3�a� Bay, Mn. � 5323
JOB SITE ADDRESS ,�I y L� r�A1_�Lf_t� J�l� � 0��1?�IER (x2.D�'_n� ��i� ti:"rC.c=
Oceupaneu Type� ___ R2a�deniial �( Comme2cia£ 0#hea: _ ____.___________
Eziet�na occupted building Neu• conet�cuction, net yez accupied
Contractor� �`tc=4'i.=. n.� (��-����- � o Telephone No. y-7 `�/ -�� `/ r
P•4ailing ?�ddress
City License No. � _ Master Pluraber ' s State License No.
PERMIT TYFE & FEE CALCULATION
MUNICIPAL SEWER CONNECTION �32o.no pea .zub ptua S.so szaze su���,a1y� • S�o.so eaek) $ I'ermit
p�p¢ size tinches; mate2iaf _PUC (�n eand p�l[1; _ ea.et thon; otheh ______
A4D FGR Mt�CC SAC CHARGE� 5425/urit X �� un<te � S��-
SAC A141ST ACCONPANf' ALL SE0.'ER P�RMI7 AFPLICA7IOAIS unleee p2epa�d. Ib prtepn.id, ehaw 1e�enence Lo:
�'zcr,pz ,Uu. Buieding Vertmit No. Gene2aC P2Rmt1 No.
NOT�S: i; A eepanate peumbLng pe2mtt mubt be ob#a.ined (�oa any <.ne�de pPumbing changes.
Z) Clzanouze muet be inbLaLte� at nighz angle b¢nde and evertu 150 6eet o,� 2un.
31 Ex�s.ttng cep.tic Lanke muai be pumped and 6iLLeC.
MUNICIPAL WATER CONNECTION �Szo.oo neA 6xub plue 5.so staze Surtchange • STo.so ea�h� � Permit
pipeiecze tnchee: mateaiaf eoppen, type _ ; orhe2 --------------- -----
ADD FCR WATER 11�7ER: 5/8" _ $6C.00; 3/4" _ $85.00 ME7ERS tAL'S7 BE PICKED tlY A7 CITV HALL. � Me t e r
uOiES� 11 Meterte mau be purtchaeed by the contaaeto� ort by Lhe prtopertty owne2.
2) Uatert pelm�ta <nc£ude <:nepectlon bc,2 m¢t¢n cnatccLGat�on. A separtate pZumb�ng pertmit mueZ
b¢ obta.ined bo-2 anu othert inaide peumbtng ehangea.
3) Cu2b e#op mua# be eet �°�u.eh Lo grtound ou2baee.
Ij WA7ER NUS7 NOT BE 7URNED ON UNTIL Ci7S' SFALS WETER - CALL WHEN REAVY.
� 3p.sv �
PRIVAT� t�7ELL INSTALLATION is2o.00 ne1 �ob n1LLe S.so Siate Sunehange - -S�-o--sro eachl $ �b � �'e��ttit
check: new Weee nepLacement we.LC nepairt ¢xieting weCG; caeing eize: Cnchee
N07ES: 1) A eepanate pfumb.i.ng penmit muet be obtained 601 any <ne<de peumb<ng ehangea. � 3��' ��������`�
21 Requin¢d min.�mum ae.�.bncka, hrtom: dhain(�Ce�d - IS 6eet aept�c xan.k - SC he¢Z F/�,�- �N�,
CALL FOR SI7E LOfA�iON 6EFORE DRILLING
3! Upon compt¢t�.on, CI7Y A1US7 BE SEN7 A COPY OF TNE S7A7E WELI RE�OR7 �
State SUr'C�'13C�� 7he State BuiLding Cod¢ OivieioK Surtchnnge od SOS pe2 pert�it hae been �ncluded above.
- 7oZal Suxchalge bon co�ibined wateR and eewe.n penn�cze <e 51.00
Postage �.17C� HdXlClling OK all walled-iK applteatione, add tht po�tage aed handling 6ee $�(�
TOTAL PERMIT FEE �':�,�...::...''""�—
The undenecyned h¢2eby appliee to Lhe City o� 02ene Fort ieauance o6 a 11711I7V PERMIT, agaeee Lo do aCL wortt� .in etaici
------__----a.ecaxdance wi.Sh the oadiaa-acee-o-�_th<_��tu.an�th�-��guCatcuae o{� the Siat¢ a� llinneeo.ta, and eenLi.��e:e-Lka.t-a�� _--- _
t#atenrexfa murle oR thia appYica#ion a�z com�+feYe, Zxue aR�t coan¢et. - "-" --"