HomeMy WebLinkAbout2005-P08457 (sewer connection) � -
CITY OF ORONO PERMIT
2750 Kelley Parkway - PO Box 66 Permit Number: Pos4s�
Crystal Bay, Minnesota 55323 Permit Type: seWer and wacer Pe�it
(952) 249-4600 Date Issued: 2�ig�2oos
SITE ADDRESS: 1070 Ferndale Rd W
Wayzata,MN 55391
P I D: 02-117-23-43-0002
DESCRIPTION:
Proposed Use: Residential
Pernut 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#6460 9/11/81
FEE SUMMARY: Pernlit Fee: � 35.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Widmer Construction LLC OWNER: Timothy&Rosie P Owens
9455 County Rd. 15 1070 Ferndale Rd W
Maple Plain,MN 55359 Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE TI�REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICI'COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND SI'ATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
���, ��x--=r�-y�-.-�'� �g�Y��-�"�'(
�
� PPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Si�nitur�es Required), 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
, .
(Updated 12/29/04)
CITY OF 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 pernlits by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Pernlit 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 permit card is available on the job site.
�. Utility connection pennits may be issued to licensed contractors only.
6. Contact the Public Works Departmeut(952-249-4600)for utility stub as-built locations. DO NOT E�CAVATE 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
approvai.
7. All work must be done in accordance with State Code requiremeuts.
8. All work must be inspected before it is covered. Call(952)249-4600,24-48 hour notice required.
JOB SITE ADDRESS: _ _ �G -�:� f.c/�— ��•��v,����
Occupancy Type: jC Residential Commercial
Owner's Name: Jy���-��l ,�;�;s;,�,�..�,:: �. /,«-�3 phone Number: �/�- ���� - ��/'
Mailing Address: ��< <i�_z��-- City: Zip•
Contractor's Name: W�/�� <<�K��.��. �;,�_.-jG�Phone Number: ys�- y�-r -s��c;�
Mailing Address: ia'y�s- u� �=�< is- Cityr>-�,��/f��/�:�-Zip• �-s=3>f'
PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One)
SAC Charge (2005 rate $1,450.00) $ (Set Rate)
Sac Charge must accompany all sewer perniit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Connection/Disconnec�/Repair ($35.00 per stub) $
pipe size�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 Dcpartment(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
1. 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 permit requested.
3. Posta�e & Handling (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 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 complete, true and correct.
,� �
Signature of Applicant: %�-3 ���_=--�-����-��-��- Date: � ��-.z>'�
I