HomeMy WebLinkAbout2003-P06823 - sewer repair � �
CITY OF R N PERMIT
� � � Permit Number:
2750 Kelley Parkway - PO Box 66 P06823
Crystal Bay, Minnesota 55323 Permit Type: Sewer and water Permit
(952) 249-4600 Date Issued: 9i24i2oo3
SITE ADDRESS: 395 Ferndale Rd N
Wayzata,MN 55391
PID: 36-118-23-41-0001
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Pernut Pernut Sub-type(s): Sewer Repair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 35.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: 7RS Companies, Inc OWNER: Damin&Rosemarie Topousis
2800 Campus Drive-Suite 40 395 Ferndale Rd N
Plymouth,MN 55441 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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A�LICANT PEl l�ITEE SIGNATURE � , [SSUED BY SIGNATURE
Covies: 1-File(Si�nitures Required), 1-Annlicant, 1-Monthlv Renorts, 1-Assessin�, 1-Finance Page 1
(Updated 6/2/03)
CITY � ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
GENERAL INFORMATION
1. You may apply for utility pernrits 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 until you receive a permit card.
4. Work must not begin unless the pernut 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 utility stub as-built locarions. DO NOT EXCAVATE IN ANY STREET AND
DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a pemut 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 required.
JOB SITE ADDRESS: �`l.� 1'y l�RTI-j I=� C��N D/1 L L= ,/Z�rA l�
Occupancy Type: ✓ Residential Cornmercial
Owner's Name: 7A� I ��}N �TU i�'e �'Si S Phone Number:
Mailing Address: 3�,� NG �27ia rL-'RN vq�� ��c,j ry City: L:,��rv r_; Zip: `�j 3�7�
Contractor's Name: ��112 RU�7 TL� Phone Number: 7�;- �, 7 l— c� -; 5 5
Mailing Address:��cJ 0 C/�N1 i��4> >R. z#'4 c� CitY: i��v��C� -�r Zip: '�S q� I
PERMIT TYPE ❑Connections LJ Kepairs ❑Disconnect (Check One)
SAC Charge (2003 rate $1,275.00) $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Connection/Disconnec epair $35.00 per stub) $
pipe size E: inches; material �'v :� Schd 40 air tested; cast iron
Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $
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'
PERMIT FEE CALCULATION
l. Subtotal of above permit requested $
2. State Surchar�e $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per permit must be
included for each well,sewer and water connection pemut requested.
3. Posta�Te &Handlin� (Only mail-in applications) $ 1.50 (Mail In Only)
4. TOTAL PERMIT FEE (add lines 1-3 above) $
The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all vv�rk �.�a �trict
accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that �Y� st�.���ents
made on this application are complete, true and correct.
Signature of Applicant: �.��� ����,5j�n��,X Date: ���� �f�C>,7