HomeMy WebLinkAbout2003-P06999 - sewer disconnect �
PERMIT
C I TY O F O RO N O Permit Number:
2750 Kelley Parkway - PO Box 66 P06999
Crystal Bay, Minnesota 55323 Permit Type: seWer ana water Pe�t
(952) 249-4600 Date Issued: 11i13i2oo3
SITE ADDRESS: 1265 Bracketts Point Rd
Wayzata,MN 55391
PID: ii-i1�-23-32-ooio
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer Disconnect
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 35.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Westonka Water& Sewer OWNER: Micheal&7orja Lynn
6501 County Rd 15 1265 Bracketts Point Rd
Mound,MN 55364 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPL[CANT PERMITEE SIGNATURE SCJED BY S[GNA�URE
Copies: 1-File(SiQnitures ReAuired). 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
(Updated 6/2/03)
CIT�'�OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
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GENERAL INFORMATION
1. You may apply for utility pernuts by mail or in person at the City offices. E
2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will be sent by rehun mail the same day `
the application is received.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the pernut card is available on the job site.
5. Utility connection pernuts 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. Issuance of a pemut does not gzant 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.
JOB SITE ADDRESS: (���� i�i'4��� ��� (��;�.�� ��c�._
Occupancy Type: }� Residential Commercial
Owner's Name: Phone Number:
Mailing Address: City: Zip:
Contractor's Name: ����f��,�� c f�..i Phone Number: �5'��.z) �f 7� _c:���E
Mailing Address: �S �/ l�', jl�. r`� City: ����.�,,� Zip: S—` -: �
PERNIIT TYPE ❑Connections ❑Repairs �Disconnect (Check One)
SAC Charge (2003 rate $1,275.00) $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
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Municipal Sewer Connection7�isc-�.pne epair ($35.00 per stub) $
pipe size inches; material Schd 40 air tested; cast iron
Municipal Water Connect�n�Disconnect/Repair ($35.00 per stub) $
pipe size in,:�ies; material copper; other
WATER METERS must be picked up and paid for at City Hall.
Water meters must be set and sealed by Orono Water Department
(952-249-4600) upon completion of ineter installation.
REQUIRED minimum setbacks from drain field and septic tanks = 75'
REQUIRED setback from sewer line =20'
PERI�IIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50 (Minimum) �
The State Building Code Division Surcharge of$.50 per pemut must be
included for each well,sewer and water connection permit requested. �
3. Posta�e &Handlin� (Only mail-in applications) $ 1.50 (Mail In Only)
4. TOTAL PERMIT FEE (add lines 1-3 above) $
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 complete, true and correct �
Signature of Applicant: Date: / � �',�
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DATE TIME
CITY OF ORONO CALLED IN I I-/? -U.�
INSPECTION NOT CE SCHEDULED /I-i�!-D� � = �Zl '�'(
PERMIT NO. 'l � COMPLETED
ADDRESS I��S �l�< C I��--� />` �T -r��
OWNER CONTR. ���Z.S��i.��tt.--
TELEPHONE N0. '�.f� � �I / 7 7 %
� DESCRIPTION �ti'-'��C !/� f C�/"��-��
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WEfLANDS
y 03 INSUTATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
W ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
❑ INSPECTION REQUIFED.CALLTO ARRANGE ACCESS.
Call forthe n t inspection 24 hours in advance. (952� 249-46��
OwnerlContra� ite:
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Inspector.
White Copy/lnspector's le Canary CopylSite Notice