HomeMy WebLinkAbout2003-P06396 - sewer connection � PERMIT
C1�Y OF ORONO Permit Number: '
2750 Kelley Parkway- PO Box 66 Po6396
Crystal Bay, Minnesota 55323 Pet'mit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: 6�9i2oo3
SITE ADDRESS: 5 Brown Rd S
I.ong Lake,MN 55356
P I D: 34-118-23-34-0009
DESCRIPTION:
Proposed Use: Residential
Pernut Class: General
Permit Type: Sewer and Water Pernut Pernut Sub-type(s): Sewer Connection
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 35.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
SAC Fee: $ 1,275.00
TOTAL FEE: $ 1,310.50
APPLICANT: Atco Utility Services OWNER: Bruce C.Mathison
3660 County Rd/ 101 S 5 Brown Rd S
Minnetonka,MN 55391 Long Lake,MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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PUCANT PER EE SI TURE ISSUED BY SIGNATURE
Copies: 1-File(Signitures Required), 1-Anplicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
(ITpdated 6/2/03)
CITY OT ORONO APPLICATION FOR UTILITY PERMITS
Boai66 �50 Kelley Parkway) SEWER/WATER& SAC � / j/vo J p
Crystal Bay, MN 55323
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GENERAL INFORVIATION
1. You may apply for utility pernuts by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will be sent by return mail the same day
the application is received.
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 pernut 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.
JOB SITE ADDRESS: S Sc�<<�G� /��-b,�.,� �G.
Occupancy Type: k Residential Cornmercial
Owner's Name: ��,��g G�i►� � ,`S„�, Phone Number: `y��Z- y7�-��9/
Mailing Address: � S G 6r�,��,/�l City: ��-,,�,� Zip: S s�s�
Contractor'sNami�d /�/,�-,�/,���°�s PhoneNumber: -r'jSZ-�j��-7zy7
Mailing Address: 3�/o ro. �� lU/ City:����— Zip: S S'��'��
PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One)
SAC Charge (2003 rate $1,275.00) $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Connection/Disconnect/Repair($35.00 per stub) $
pipe size �I L/ , inches; material Schd 40 air tested; cast iron
�i
.�Iunicipal Water Connection/Disconnect/Repair ($35.00 per stub) $
pipe size inches; material copper; other
WATER METERS must be picked up and paid for at City Hall.
Water meters must be set and sealed by Orono Water Department
(952-249-4600) upon completion of ineter installation.
REQUIRED minimum setbacks from drain field and septic tanks= 75'
REQUIRED setback from sewer line=20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per pernut must be
included for each well,sewer and water connection permit requested.
3. Posta�e &Handlin�(Only mail-in applications) $ 1.50 (Mail In Only)
4. TOTAL PERMIT FEE (add lines 1-3 above) $
The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict t
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 co lete, true and correct.
Signature of Applicant: ��%��� .cr--- Date: � � � l�3
DAT v
E TIME
CITY OF ORONO CALLED IN 'd �
INSPECTION NO CE , ,� SCHEDULED �Cr �'3��
PERMIT N0. COMPLETED � �����
ADDRESS � ��l`(JI� /l�ct/ � ,J
OWNER CONTR. G�
TELEPHONE NO. �S � �7 � 7�y�
� DESCRIPTION C .c.I`�-'� �
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAI 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
� OWNERICONTRACTOR TO MEET YOU: ES_NO
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W� ❑WORKSATISFACTORY:PROCEED �PROJECTCOMPLEfE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� O CORRECT WORK,CALI FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
O INSPECTION RE�UIRED.CALLTOARRANGEACCESS.
Call forthe next inspection 24 ours in advance. (952� 249-46��
OwnerlContr or on site: `
Inspector.
White Copy/lnspector's File Canary Copy/Site Notice