HomeMy WebLinkAbout2003-P07093 - sewer disconnect PERMIT �r�'`' ��� �,
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 P07093
Crystal Bay, Minnesota 55323 Pe►-mit Type: sewer and water Pernut
(952) 249-4F;� Date Issued: 12ii2izoo3
�
SITE ADDRESS: 3445 Crystal Bay Rd
Wayzata,MN 55391
P I D: 17-117-23-43-0121
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:
Sewer&Water Disconnect
FEE SUMMARY: Permit Fee: $ 70.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: V P Enterprises OWNER: Fred 7ohnson
P.O. Box 15 3445 County Road 44
Wayzata,MN 55391 Minnetrista,MN 55364
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.
�+� . n ���--� t G;�Cl r? '/�
l:.
�v L :;�'t-- �.v
APPL[CANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Covies: 1-File(Si�nitures Required). 1-Avplicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
(Updated 6/2/03)
CITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
GENERAL INFORI�IATION
1. You may apply for utility permits by mail or in person at the City offices.
2. Maile�in applications are subject to the postage and handling fee shown below. Permit cards will be sent by return mail the same day
the applicarion is received.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the permit card is available on the job site.
5. Utility connecrion permits may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600)for utility stub 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 permit does not gtant this approval.
7. All work must be done in accordance with State Code requu-ements.
8. All work must be inspected before it is covered. Call(9�2)2-�9-4600,24 hour notice required.
JOB SITE ADDRESS: � / I � ����U' ` �, L �
Occupancy Typ� Resident t - Commercial
Owner's Name: 1 ;� �� ^��lv�-�c-� �- Phone Number:��il ��� / ;� ��/
Nlailing Address: --�-------- City: Zip:
Contractor's Name: � /V �`/'f i3/5 0 )')'�,�,` ��h7 Phone Number: ��S Z- �1�� ��/7��
Mailing Address: ���: ��� ,�� � City:����{z.���-� ZiP' S'����,L
PERMIT TYPE ❑Connections '
❑Repairs isconnect (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)
� ��.
,
Municipal Sewer Connection/Disconnect/Repair (535.00 per stub) $ � -� i c-'
pipe size inches; material Schd�0 air tested; cast iron
Municipal Water Connection/Disconnect/Repair (S35.00 per stub) $
� �� �=% c_�
pipe size inches; material copper; other
WATER METERS must be picked up and paid for at Cit�-Hall.
Water meters must be set and sealed by Orono«"ater 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'
PERi1�IIT FEE CALCULATION
1. Subtotal of above permit requested $ �i C-� -'
2. State Surcharae $ �.50 (Minimum)
The State Building Code Division Surcharge of$.50 per permit must be
included for each well,sewer and water connection pemut re�uested. �
3. Posta�e & Handling (Only mail-in applications) $ 1.50 (Mail In Only)
4. TOTAL PERMIT FEE (add lines 1-3 above) $�-7�; ��-=
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 cor�e-' rue and correct.
__ .
--_ __.._. _. _�--�_----�._-______..__ `�_/Z ���
Signature ofApplicant; --- �"'� _ --------- - --- ' Date:
��`---