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Home My WebLink About2013-00281 - sewer disconnect „ CITY OF ORONO � 1 3 - 0 0 z� 2750 KELLEY PARKWAY DATE ISSUED: 06/20/2013 ' ORONO, MN 55356- � (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1510 NORTH ARM DR P1N : 08-117-23-33-0078 LEGAL DESC : HICKORY HILL : LOT 020 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 ATLAS HOMES INC STATE SURCHARGE SEWER&WATER 5.00 14450 117TH AVE N TOTAL 55.00 DAYTON, MN 55369- (763)691-9044 Minnesota State License#: BC20269686 OWNER Real Assets LLC 550 25TH AVENUE N ST CLOUD, MN 56303- 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 describcd and does not grant permission for addi[ional or related work which requires separate permits. All provisions oY laws and ordinances governing this type of work shall be compied with whether or not specitied 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. � ��--�-�� s— � /"z� / �c��.Z� / / Applicant Permitee Signature Date Issued By Si ture Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED B VE. � . -��- � FQR CI Y L1SE ONLY ¢ '��1 l�% City Of Orono Date Received:�� a�� Permit# l —d 0�p � a \ P.O.Box 66 � 2750 Kelley Parkway ❑ In-fiouse SAC Det�rniination Porm Completed 1 ��y �� Crystal Bay,MN 5�323 �``�t �� (952)249-4600 Approved By Qf 2equired): \.,�1KJ�c'rt�t� ," . CITY OF ORONO— SEWER & W ATER/ GENERAL PERMIT (*Note:Some permits may require approval by the I3uilding Oflicial and/or Public Works Department*) (ALL PERMI"I'S- �4av be subiect to further review and mav not be issued when the annlication is received) GENERAL INFORMATION l. 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. [ssuance 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 ❑ Water Availability Connection For Future Hook-Up to Water Job Site / Owner Information: Site Address: � `� I C �Uo(j"l� f�i� Owner: In'��<t` /.T`��5 � Mailing Address: �50 Z 5�`� /-��-+'� city: 5 1 ��v�� zip: s�6 3 0 3 Home Phone: ✓��- �� `' �� Alternate Phone: � Contractor Information: Contractor: �+�u 5 ��"�� Contact Person: �� y Address: � �`�S�' �� '� '�f State License #: aL Zo 1 �, `i �, S� City: � �`�- Zip: �'� Expiration Date: �`� �� `� Phone: �� `�� Alternate Phone: ��3 �� DE'TER�III�tING PERMIT FEE� � ❑ SAC Charge(2013 Rate=$2,435.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staff can determine if apnlicable) (If not prepaid,a sewer connection permit will not be issued) �SP pe s Zennectio'p�scmater al �e�a'Schd 40 aP te Sedb) cast ir n � �, Z ❑ Water Connection/ Disconnect/Repair($50.00/Per Stub) $ Pipe size inches; material Schd 40 air tested; copper ❑ Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Explanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Required Before Water Connection Permit is Issued: l. Issue Water Meter& Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Permit Fee& Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ ��' �� 2. STATE SURCHARGE $ 5.00 3. POSTAGE& HANDLING(Only on Mail-In Applications) $ .'1�0 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ �„J, �� ADDITIONAL INFORMATION—WATER METERS ■ WATER METERS must be picked up and paid for at Orono Ciry Hall,these are on a separate permit. ■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon completion of ineter installation. The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict accordance witll tl�e 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. I � I 7 Applicant: V VC� Date: UL� / Z`� � � �