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Home My WebLink About2009-00642 - septic repair � CITY OF ORONO PERMIT NO.: 2009-00642 2750 KELLEY PARKWAY ORONO, MN 55356- �ATE iSSUEn: 09/28/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 4355 CHIPPEWA LA PIN : 31-118-23-42-0020 LEGAL DESC : N/A : LOT 000 BLOCK 000 PERMIT TYPE : SEPT[C PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : REPAIR ��L�C�uJ rro�rE: REPAIR EXISTING PRECAST CONCRETE TANK APPLICANT SEPTIC REPAIR 100.00 HAYES& SONS EXC. INC. STATE SURCHARGE SEPTIC 0.50 263 82ND STREET S.E. TOTAL 100.50 MONTROSE, MN 55303- (763)479-1762 PAID WITH CC# 4286 Minnesota State License#: 640 OWNER YOUNG,JOHN& LYNN 4355 CHIPPEWA LA MAPLE PLAIN, MN 55359- 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 a time or due cause. l2 j l � t..��`� �'� �lw l �/ � App icant Pe ' ee Signature Date Issue y Signature Date SEPARATE PERMITS REQUIRED FOR WORK O ER THAN DESCRIBED ABOVE. � . g�� City of Orono FQR CITY USE ONLY �:r, � P.O. Box 66 �•��7 d ��'�''1�- ��-- �,,,., 2750 Kelley Parkway Date Receive Permit# a ��'�'��; .. Crystal Bay MN 55323 �-7� � t,L;';�" ,� Amount: $ �0�.J � �^'�(,��;.��F��$o (952)249-4600 ��a9H� CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION (All permits must be approved by the On-Site Septic Manager and/or Building Official) ��Job Site / Owner lnformation: �� 4�� : ' Site Address:_ � �� C�i,P�p-e.w A- �� r---- Owner: � u� � �o��E Mailing Address: Lf 35�� ,'��E��„�y �-�-' : �� City: /�G� � ��. Zip: 5 S3�/ Home Phone: Alternate Phone: Contractor/Applicant Information �.,� Contractor/App.: �. -25 , '�s Contact Person: �-� Address 2�= 3 ��2�� S�� S� � State License #: � �� c City: �°'�fi�v� Zip: S'`� 36� Expiration Date: �C_ � Phone: � G3 — �{`7 � � l '� � `Z �t � ,� Alter.�ate-�.hone: L-P (2 Co � �r S� � °' � � �� TY�E� OF OC�CUPANCY �esidential ❑ Commercial ❑ Other PERMIT TYPE AND FEES New or Replacement System $200.00 _....__ _ Repair Existing System � 100.00 /��•� ks or Drainfield) State Surcharge .50 .50 Total � �� G �� V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc 1 / 2 , , ** ATTENTION APPLICANT ** -� � �� Fili in all appropriate blanks and check all appropriate boxes. I I wilt be installing the following: Tanks- �Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other (list manufacturer) Number of Tanks: ��^�-u-'t`'� 1.�.�-,�<<, ,',.. —' , �� Size of Tanks: Treatment System Trenches s.f. � Mound s.f. ` Gravel less . s.f. �,amber s.f. �. _ �� Final Cover/ Top Soil., .�� , to be borrowed from si how location on site plan) �-.`_ trucked in The undersigned hereby applies to the City of Orono for issuance of a septic system installation permit, agrees to do all the work in strict accordance with ordinances of the City and regulations of the State of Minnesota and certifies that all statements made on this application are complete, true and correct. -�--� ___. Signature of Applicant Date: �� Z� �� MPCA License No.: � � �_� Sta�f Review: Accept ❑ Denied Reviewer: ��.�t� Date: �� Reason for Denial: Comments (to be printed on inspection card): V:\(Permits)\Septic Permit Application-New Permit Fees 2009.doc 2 � 2 � '� �� `�/ `"' q/ DATE/ TIME "' CITY OF ORONO � CALLED IN `/ �` O INSPECTION N /T�I�jE /)/)/A SCHEDULED ��¢��Z�.�, � - G'� PERMIT NO. ��/v �`"�`��/COMPLETED ADDRESS 355 �`-� OWNER CONTR. �ILZL�I�/y TELEPHONE NO. ' J � `7 , � DESCRIPTION � V� � ❑ FOOTING � ME ICAL RI ❑ EXCAV/GRADING/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT Q � DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP _ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL J ❑ PIUMBING FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � o .�-!� S -�-�a � � �(� "�-O ��v `f, c��c° '� S � � � � 1 -� � 0 � W � Q � Z W � W � � d W� ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED CI ISSUE CERTIFICATE OF OCCUPANCY � ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WlLL RETURN !�CITATION ISSUED �STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALLTOARRANGE ACCESS. Call forthe next inspection 24 hours in advance. �95Z� Z49-4600 OwnedContractor on te: Inspector. � .,`�: � White Copyllnspector's File Canary Copy/Site Notice