HomeMy WebLinkAbout2007-P11455 - sewer connect PERMIT
CITY OF ORONO Permit Number:
2750 KP!ley Parkway- PO Box 66 P11455
G4ystal E�ay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 24�-4600 Date Issued:
9/17/2007
SITE ADDRES�: 3090 Farview La Unit#
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C,ong Lake,MN 55356
P��� 04-117-23-34-0011
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer Connecrion
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
SAC Paid#5045 -06/17/83
FEE SUMMARY: Permit Fee: $ 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Glenn Rehbein Exc. Inc. OWNER: Robert& Sarah Schmidt
8651 Naples Street NE 3090 Farview La
Blaine,MN 55449 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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APPLICANT PERMITEE SIGNATURE [SSUED BY SIGNATURE
Copies: l-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
FOR CITY USE ONLY
�%���, Clty of Ol'ono Date Received: Permit#
1/f� '�O P.O.Box 66 ��
t a'.,,,,�,. 2750 Kelley Pazkway ❑In-House SAC Determination Form Completed
� y�1'x. �. �. Crystal Bay,MN 55323 ^�
��� '�+��`:,,*�o�' (952)249-4600 Approved By(If Required): /J�'
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CITY OF ORONO—SEWER& WATER/GENERAL PERMIT UU
(*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 not be issued when the aunlication is received) �
GENERAL INFORMATION �/
� � �
1. You may apply for utility permits by maii 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 egpress
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 �Re-Connection �Repairs ❑Disconnect
Job Site/Owner Information:
Site Address: 30�i'D F�J��� �M�,
Owner:�.r'-�f�ta�1��M i�(�- Mailing Address:
c�ty: �na z�p: 55 3�3
Home Phone:9�� -��N-2-��y Alternate Phone:
Contractor Information:
Contractor: Glenn Rehbein Exc, Inc. Contact Person: John Carlisle
8651 Naples Street NE ���8
Address: State License#: �
C�tY� Rlaina Zip:5544q Expiration Date: I.Z �� ���7
Phone: (612) 919-2019 Alternate Phone: (763) 784-0657
.
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 )y" inches;materialSDQ�i Schd 40 air tested; � cast iron
❑Water Connection/Disconnect/Repair($35.00/Per Stub� $
Pipe size inches;material Schd 40 air tested; copper
1. SUBTOTAL of Permit Requested: $ 35- o O
2. STAT'E SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ,35•S O
ADDITIONAL INFORMATION—WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate 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: li•�•� L . Date: � ��
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