HomeMy WebLinkAbout2006-P10622 - sewer & water permit � � � PERMIT
CIT�( OF ORONO
Permit Number:
2750 K�Iley Parkway- PO Box 66 P10622
Crystal Bay, Minnesota 55323 Permit Type:
Sewer and Water Pernut
(952) 249-4600 Date Issued:
12/7/2006
SITE ADDRESS: 753 Boulder Dr Unit#
Long Lake,MN 55356
PID: 33-118-23-11-0074
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required: Water Connection Sewer Connection Other-O
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 70.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Groth Water&Sewer OWNER: O.T. Development, LLC
775 Tower Drive 10300 lOth Avenue N#101
Hamel,MN 55340 Plymouth,MN 55441
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
MINNESOTA BUILDING CODE REQUIREMENTS.
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A LICANT PERMITEE SIGNATURE IS D BY SIGNATURE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1�
. � �,
-EOR CITY USE ONLY
��� City of Orono Date Received Permit#
P.O.Box 66
�� � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
a �Il���� �' Crystal Bay,MN 55323
�� �; u `�o o~ (952)249-4600 Approved By(If Required):
t��th�'��,s
'�sexo
CITY OF ORONO— S�WER& WATER/ GENERAL PERMIT
(*Note:Some permits may require approval by the Building Ofticial and/or Public Works Depar[ment*)
(ALL PERMITS N[av be subiect to Curther review and m�v not be issued when the annlication is reccived)
GENERAL INFORMATION �
1. You may apply for utility pennits by mail or in person at the City offices.
2. Mailed in appiications are subject to the postage and l�andling fee shown b�lo�v. Pernut cards will
be sent by rettu-n mail within 2 business days.
3. Permits are not valid until you receive a pernut card.
4. Work must not begin unless the pernut card is available on the job site.
5. Utility coiuiection permits may be issued to licensed coiihactors only.
6. Contact the Public Works Department(952-249-4600) for utility shib as-built locarions.
DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express
approval of the Public Works Department. Issuance of a pemut does not grant this approval.
7. All work must be done in accordance with State Code requirements.
S. All work inust be inspected before it is covered. Call(952)249-4600,24+hour notice required.
TYPE OF PERMIT
(Check All That ApP1Y) ',
�] Residential(May Require Approval) ❑ Commercial(Approval Required)
� New Connection ❑ Additional Connecrion ❑Re-Connection ❑Repairs ❑Disconnect
Job Site/ O�mer L�.formation:
Site Address: � S � .LL��� ��
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
�
Contractor�D� � � Contact Person: !V �.
Address: � 7 S t,��� � State License#: �l��-
City: � Zip: ��3 7�;xp;ratioi�Date: / � � ` � �
Phone: � / � 9/���,� Alternate Phone: ������z_�� �
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- I)ETERMINING PERMIT FEES;
❑ SAC Charge(2005 Rate=$1,550.00) $
(SAC Charge must accompany all sewer pernut applications unless prepaid)
(Orouo City Staff can determuie if applicable)
(If not prepaid,a sewer connection permit wili not be issued)
�Sewer Connection/Disconnect/Rep ir($35.00/Per Stub) $
�� Pipe size�inches;material�Scl�d 40 air tested; cast iron
�\'Vater Connection/Disconnect/Repair($35.00/Per Stub) �
Pipe size�inches; material('��(1_Schd 40 air tested; copper
�.,�
1. SUBTOTAL of Pernut 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 1VIETERS
■ WATER METERS must be picked u�and paid for at Orono City Hall, these are on a separate pernut.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of inetei•installation.
The undersigned hereby applies to the City of Orono for issuance of a Utility Pennit, agrees to do
all work in shict 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 con-ect.
c Date: � lJ
Applicant: � � � ��