HomeMy WebLinkAbout2004-P07686 - sewer/water [permit PERMIT
C�T�'"�OF ORONO Permit ►vumber:
2750 Kelley Parkway - PO Box 66 P07686
`Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: ��s�2ooa
SITE ADDRESS: 65 Cygnet Pl
Long Lake,MN 55356
PID: 04-117-23-22-0008
DESCRIPTION:
Proposed Use: Residential
Pernut Class: General
Permit Type: Sewer and Water Pernut Permit Sub-type(s): Sewer Repair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Repair-Adding footage because house was moved and need to re
FEE SUMMARY: Permit Fee: $ 35.00 Vatuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
Af�PLICANT: �chfield Plumbing Co. Inc. OWNER: Kevin&Michelle Krokzyk
8640 Harriet Ave S -Suite#100 65 Cygnet Pl
Bloomington,MN 55420 Long Lake,MN 55356
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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AP L[CANT MITEESI NATURE ISSU BYSIGNATURE
Copies: 1-File(Si�nitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
a. (Updated 1/5/04)
CITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER & SAC
Crystal Bay, MN 55323
GENERAL INFORMATION
1. Yo�i ivay apply for utility�ennits by mail or in person at the City oftices.
2. Mailed in applicltions are subject to the postage and handling fec shown below. Pennit cards will be sent by retum mail the same day
ihc application is rcccived.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the penuit card is available on the job site.
5. Utilily connection permits may be issued to licensed conlractors 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 MA lN without express approval of thc Public Works Department. Issuance of a permit does not grant this approval.
7. All work must bc donc in accordance with State Codc rcquiren�cnts.
8. All work inust be inspected before it is covered. Call (952)249-4600,24 liour notice required.
JOB SITE ADDRESS: S ��G��-
Occupancy Type: �'`- Reside Y 1 Commercial
Owner's Name: In d- �� LZ �- Phone Number:
Mailing Address: � City: Zip: ,s �
Contractor's Name: l Gr "1'� • Phone Number: — � .33�
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MailingAddress: .S� 6l� City: �{ Zip: �Sy2� v
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PERMIT TYPE ❑ Connections �Zepairs ❑Disconnect (Check One) .j �
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SAC Charge (2003 rate $1,350.00) $ (Set Rate) „��� �
Sac Charge must acco�npany all sewer permit applications unless prepaid. ,�(�� �9'�
(If not prepaid, a sewer connection will not be issued) �� ��
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Municipal Sewer Connection/Disconnect Repair $35.00 per stub) $ �S � L�
pipe size_� inches; inaterial P�r�Ci Schd 40 air tested; cast iron '�-� _ � �
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Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $ �
pipe size inches; �naterial copper; other ��a
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WATER METERS must be piciced up and paid for at City Hall. ��
Water meters must be set and sealed by Orono Water Department
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(952-249-4600) upon completion of ineter installation. �-'
REQUIRED minimtiim setbacks froin drain field and septic tanks = 7S �,�
REQUIRED setback from sewer line= 20'
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PERMIT FEE CALCULA7'ION � �� �
]. Subtotal of above per�nit requested $ � �• � �
2. State Surchar�e $ .50 (Miniinum) ��
The State E3uilding Code Division Surcharge of$.50 per permit must be
included ior each well,sewer and watcr connection pennit requested.
3. Posta�e & I�andlin�(Only mail-in applications) $ � (Mail In Only)
4. TOTAL PERMIT FEE (add lines 1-3 above) $ �S_ ��
The undersigned hereby applies to the City of Orono for issuance of a Utility Pennit, agrees to do ali wark in strict
accordance with the ordii�ances 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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