HomeMy WebLinkAbout2006-P09986 - sewer & water connection PERMIT
CITY O� ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P09986
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued:
6/14/2006
SITE ADDRESS: 767 Boulder Dr Unit#
Long Lake,MN 55356
P��� 33-118-23-11-0006
DESCRIPTION:
Proposed Use: Residential
Permit Class: General COrMeGe'l��
Permit Type:
Sewer and Water Perniit Permit Sub-type(s): Sewer&Water�C
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
SAC Paid#P09830-OS/26/06
FEE SUMMARY: Permit Fee: $ 70.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Groth Water&Sewer OWNER: Paula Zachman
775 Tower Drive 2466 Dunwoody Ave
Hamel,MN 55340 Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROV ENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORON RDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS. ,� /
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APPLICANT PERMITEE S[GNATURE ISSUED BY SIGNATURE
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Copies: 1-File(Signatures Required), ]-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
PERMIT
CITY OF ORONO
2750 Ke�ley Parkway- PO Box 66 Permit Number: po9986
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
6/14/2006
SITE ADDRESS: 767 Boulder Dr Unit#
Long Lake,MN 55356
PID: 33-118-23-11-0006
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer&Water Disconnecti<
DETAILS:
Approved perresolution#:
Separate permits required:
NOTICES/REMARKS:
SAC Paid#P09830-OS/26/06
FEE SUMMARY: Pernut Fee: $ 70.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Paula Zachman OWNER:
2466 Dunwoody Ave
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
MINNESOTA BUILDING CODE REQUIREMENTS.
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APP ICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
FOR C[TY USE ONLY
¢0�` City Of OCOnO Date Received: Permit# ��
"Y P.O.Box 66
�;r;. � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed �'Z����
� ��j>>u�E'. �� Crystal[3ay,MN 55323
d�������o�o (952)249-4600 Approved By(If Required): ��
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CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT
(*Note:Some permits may reyuire approval by the Building Official and/or PuUlic Works Department')
(AI I PERMITS- Mav be subicct to furthcr review and mav not be issucd when thc application is rcccived)
GENERAL INFORMATION
1. You may apply for utility pennits 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 rehirn mail within 2 business days.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the pern�it card is available on the job site.
5. Utility coimection permits may be issued to licensed conhactors only.
6. Contact the Public Works Department(952-249-4600)for utility shib 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.
TYPE OF PERMIT
(Check All That Apply)
[� Residential(May Require Approval) ❑ Commercial(Approval Required)
�New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑Disconnect
Job Site/ Owner Information:
Site Address: �� t�t C� ��
Owner:��yC ������./l,� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
i
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Contractor�����U/ _-����--� Contact Person: � l � � �������
Address: ��S( �J � �� Y� State License#: ,�l � �
City: ����"I �'-�GLfr���Lip;����GExpiration Date: � � � / � S-�
Phone: �` � L[�?f G.� 7� � Alternate Phone: � / � �f � � 2 � �
DETERMINTNG PERMIT FEES '
❑ SAC Charge(2005 Rate=$1,550.00) $
(SAC Charge must accompany all sewer pernut applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
�Sewer Conne tion/Disconnect/Repair($35.00/Per Stub) $
Pipe size�inches;material Schd 40 air tested; cast iron
�]`Water Connection/llisconnect/Repair($35.00/Per Stub) $
Pipe size_�_inches; material Schd 40 air tested; copper
1. SUBTOTAL of Permit 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 pernut.
■ WATE12 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 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: e ' Date: _��� Q �