HomeMy WebLinkAbout2005-P09417 - sewer disconnect PERMIT
�iTY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 P09417
«�,Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
'(952) 249-4600 Date Issued:
11/14/2005
SITE ADDRESS: 1500 Bohns Pt Rd Unit#
Wayzata,MN 55391
P��� 09-117-23-33-0005
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: Pete's Water&Sewer,Inc. OWNER: Andy Anderson
800 Lowry Avenue NE 201 E. Lake Street-Suite 242
Minneapolis,MN 55418 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
M[NNESOTA BUILDING CODE REQUIREMENTS.
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� ' APPLIC T PERMITEE SIGNATURE [SSUED BY SIGNATURE
Copies: I-File(SignaturesRequired), 1-Applicant, 1-MonthlyReports, 1-Assessing,(IfSeptic, 1-Septic) Pagel
� FOR CITY USE ONLY
,���, CitV of Orono Date Received: ! -:v �'� Permit# l�C�3`�ll 7
O.. O P•O.Box 66
�, � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
� �������,;� h�* Crystal Bay,MN 55323
�^i T�n,�.�o (9�2)249-4600 Approved By(If Required):
'�saxo$' �
CITY OF ORONO—SEWER & WATER/ GENERAL PERMIT �5 5� S�
(*Note:Some permits may require approval by t11e Building Official and/or Public Worhs Department*)
(ALL PERMITS- Mav be sublect to further review and mav not be issucd when the application is received)
GENERAL INFORMATION
1. You may apply for utility permits by mail or in person at the City offices.
2. Mailed in applications are subject to flie postage and handlinQ fee shown below. Permit cards will
be sent by returu mail within 2 business days. �
3. Permits are not valid until you receive a pernut card.
4. Work must not begin unless tl�e peinut 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-buiit locations.
DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express
approval of the Public Works Departn�ent. Issuance of a pennit does not grant this approval.
7. All�vork must be done in accordance with State Code requuements.
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 �.Discomlect
Job Site/ Owner Information:
.
Site Address: /:j � J � �d �
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
� �`�'• .
Contractor: ' � / Contact Person: �
Address: �d t ���State License #: ?�Z���
City: Zip: jS1/f5�xpiration Date: /Z — 3� � d S
Phone: `�`y 7 �y- G i� � Alternate Phone: �/Z - .3�3 -- y�yl�
DETERMINING PERMIT FEES
❑ SAC Charge(2005 Rate=$1,450.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can deternune if applicable)
(If not prepaid, a sewer connection permit will not be issued)
�.Sewer Connection/ isconne�epair($35.00/Per Stub) $
Pipe size inches; material Schd 40 air tested; cast iron
❑Water Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; copper
1. SUBTOTAL of Perinit 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 METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate pemut.
■ 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 sh-ict 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, true and correct.
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Applicant: Date: // —�y—�.S
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