HomeMy WebLinkAbout2007-P11452 - sewer connect PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p11452
Crysta! Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
�°52) 249-4600 Date Issued: 9/17/2007
SITE ADDRESS: 3083 Farview La Unit#
Long Lake,MN 55356
P��� 04-117-23-33-0005
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer Connection
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
SAC Paid#3568-07/12/1977
FEE SUMMARY: Permit Fee: $ 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Carolyn Byers OWNER:
3083 Farview La
Long Lake,MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK fN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
�iv1� Y�.. -.Lyi-'G-f/ ,L. � "- �.• � f �(...1.;y/� I`/`i7.i
APPLICANT PERMITEE SIGNATURE ISSUED Y SIGNATURE
Copies: 1-File(SignaturesRequired), 1-Applicant, ]-MonthlyReports, 1-Assessing,(IfSeptic, 1-Septic) Page 1
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,�.�1 j��5�-
� FOR CITY USE ONLY �
' jl�`�'�, City of Orono Date Received; Permit# �
,�0� '�4, P.O.Box 66 ��
t >1;,,,_,. � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed �7
� }�1'l�.'. a.� Crystal Bay,MN 55323 � �,�(p� �
`\�'��'��f�:,;��ofi (952)249-4600 Approved By(If Required): � ��", I�
���.g•� � �a-
� CITY OF ORONO—SEWER& WATER/GENERAL PERMIT �
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
(ALL PERMITS- Mav be subiect to further review and mav uot be issued when the application is received)
GENERAL INFORMATION
1. 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 EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express
approval of the Public Works Department. Issuance of a permit 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 notice required.
TYPE OF PERMIT
(Check All That A 1
,�,�esidential(May Require Approval) �Commercial(Approval Required)
�New Connection ❑Additional Connection a Re-Connection �Repairs ❑Disconnect
Job Site/Owner Information:
Site Address: 3083 �a-� r��trJ L��
Owner:Ca-�'D��/'t B�¢�/'S Mailing Address:
c��y: dr�v z�p: �53a 3
Home Phone:�152-4-15-13810 Alternate Phone:
Contractor Information:
Contractor: Glenn Rehbein Exc, Inc. ContactPerson: John Carlisle
8651 Naples Street NE
Address: State License#: �d�o.�g8
City: Blaine Zip:5541,9 ExpirationDate: �z�3//D7
Phone: (612) 919-2019 Alternate Phone: (763) 784-0657
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' �-�r . : �; . 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) $ ,35•00
Pipe size 1�".,�� inches;materialSDQ11 Schd 40 air tested; 0 cast iron
❑Water Connection/Disconnect/Repair($35.00/Per Stub� $
Pipe size inches;material Schd 40 air tested; copper
1. StiBTOTAL of Permit Requested: $ .��00
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ .35.50
ADDITIONAL INFORMATION—WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a sevarate permit.
■ 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: � I7 D
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