HomeMy WebLinkAbout2007-P10727 - sewer connection � PERMIT
CITY OF, ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: P10727
Crystal Bay, Minnesota 55323 Permit Type: Sewer and water Permit
(952) 249-4600 Date Issued:
1/29/2007
SITE ADDRESS: 1225 Dickenson St Unit#
Wayzata,MN 55391
PID: 02-117-23-31-0048
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Typc:
Sewer and Water Permit Permit Sub-type(s): Sewer Connection
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
SAC Paid#6909- 12/21/82
FEE SUMMARY: Permit Fee: � 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Wruck Excavaring,Inc. OWNER: Mathew&Michelle Hofinann
ll 187 Katherine Ave 15472 Fillmore St.NW
Becker,MN 55308 Elk River,MN 55330
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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APPLI NT PGRMITEE SIGNATURI? ISS ED BY SIG ATURE
Copies: t-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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FOR CITY USE OtiLY
,��`., City of Orono Date Received: Pennit# � �����
iO�O`�`O`�� P.O.Box66 �
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ti 2750 Kelley Parkway /�In-House SAC Detcrmination Form Completed �� �
� n���- � �,�� Crystal Bay,MN>5323 f���� ��'a
��d s'� �'r�.i$G`�i (9�2)249-4600 ApprovedE3y(IfKequired):
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CITY OF ORONO—SEWER& WATER/GENERAL PERMIT
(*Note:Some permits mav requirc approval by the Building OYficial and/or Public Works Department*)
(AL1,PERJIITS- 1�tA�°bc subiect to further review and mav not be issued when the application is received)
GENERAL INFORMATION
l. You may apply for utility permits 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 return mail within 2 business days.
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 connection permits may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations.
DO NOT EaCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express
approval of the Public Works Department. Issuance of a pennit 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 ootice required.
TYPE OF PERMIT
(Check All That A I )
�Residential (May Require Approval) � Commercial (Approval Required)
� New Connection ❑ Additional Connection � Re-Connection � Repairs � Disconnect
Job Site/ Owner Information:
Site Address: !��S �� [ v�r�5��� � f-
Owner: C.f�v''�Aiut (�✓iStR�chu.����""`��ilingAddress: ��i��v�S fi /lwn:;e S r
City: ��lx'i���'v e✓' Zip. �,�
Home Phone: ��� 3���,,:��9S Alternate Phone:
Contractor Inforination:
Contractor: �,'R��u �=z�dN�►+��� !�+� Contact Person: � ��'�y �.'R�l ��
Address: � �1 `3 � ��A�t�e�',r�t ���- State License #: c�,71 N
City: (�fC�� Zip:..�s.ju3 Expiration Date: yIQ�
Phone: s,�.o-c�1��' i��S��' Alternate Phone: 7 e j � v���' �I 7 I
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DETERMINING PERMIT FEES
� SAC Charge(2007 Rate=$1,675.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
�}Sewer Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size �/ `� inches; material Schd 40 air tested; 0 cast iron
❑ Water Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; 0 copper
I. SUBTOTAL of Permit Requested: $
2. STATE SURCNARGE $ .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 ep rmit.
■ WATER 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.
Applicant: � � ��' ��- Date: %-c�Q'c�]
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