HomeMy WebLinkAbout2004-P07232 - sewer/water connect PERMIT
C�T�� OF ORONO Permit ►vumber:
2��0 Kelley Parkway - PO Box 66 P07232
CCyStal Bay, Minnesota 55323 P21'�711t Type: Sewer and WaterPermit
(952) 249-4600 Date Issued: zii2i2oo4
SITE ADDRESS: 3445 Crystal Bay Rd
Wayzata,MN 55391
���: 17-117-23-43-0121
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:
NOTICES/REMARKS:
SAC being reclaimed from 12/03
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
Tf�LJNDERSIGNID HEREBY REQUESTS PEItMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCFS AND STATE OF (/
MINNESOTA BUII,DING CODE REQUIRF.MENTS. 'LJ t�
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APPLIC T R ITEE SIGNATURE ISSUED I3Y SIGNATURE
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Cooies: 1-File(SiQ�aitures Required), 1-Applicant. 1-Monthlv Reports, 1-A�.sessin�, 1-Finance Page 1
F (Updated 6/2/03)
CITY OF ORONO y� �`1���APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) r� � SEWER/WATER& SAC
Crystal Ba�'j�,MN 55323 �}_ ��D �
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GE�IERAL INFORMATION
1. You may apply for utility pernuts by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will be sent by return mail the same day
the application is received.
3. Permits are not valid u�til you receive a permit card.
4. Work must not begin unless the permit 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 urility 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 permit 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 r uired.
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JOB SITE ADDRESS: - �S^ � �� �� /� r � � �
Occupancy Type• Residential ommercial //
O�i•ner's Name: :����� �_/��U�– Phone Number: ��� - �C%/� s�Y ��
iviailing Address: -------- �� City: Zip: .--
Contractor s Name: ��.- ' E'i��-��%• Phone Number:
Mailing Address: � City: Zip: �V�
PERMIT TYPE Connections ❑Repairs ❑Disconnect (Check One) � �
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SAC Charge (2003 rate $1,275.00) $ (Set Rate)
5ac 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 o nection/Disconnec�t/R�e ir ($35.00 per stub) $
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pipe size inches; material "( Schd 40 air tested; cast iron
Nlunicipal Water Connection/Disconnec e 'r($35.00 per stub) $ �S/ �J
pipe size�inches; 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'
PERIVIIT FEE CALCULATION
l. Subtotal of above permit requested $ � ��
2. State Surchar�e $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per pernut must be
included for each well,sewer and water connection pemut requested. �
3. Postage & Handlin� (Only mail-in applications) $ 1.50 (Mail In Only)
4. TOTAL PERMIT FEE (add lines 1-3 above) $ ��- c'�J
The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict
accordance w�ith the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements
made on this application are cQ�pl rue and correct,_____ __
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Si�ature of�lic _ - —� Date: 2– ��
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