HomeMy WebLinkAbout2008-11804 - repair septic system � �
PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p11804
Crystal Bay, Minnesota 55323 Permit Type: Septic
(952) 249-4600 Date Issued: i/29/2008
SITE ADDRESS: 1540 Fox St Unit#
Wayrata,MN 55391
PID: 02-ll7-23-32-0003
DESCRIPTION:
Proposcd Usc: Residential
Permit Class: General
Se hc Permit Sub-type(s): Repair Sepric System
Permit Type: P
DETAILS:
Approved per resolution#:
Scparate permits required:
NOTICES/REMARKS:
Install New Sepric Tank for Pool House
FEE SUMMARY: Permit Fee: $ 50.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 50.50
APPLICANT: Elmer J.Peterson Company OWNER: David&Elizabeth Weyerhaeuser
5921 Dague Ave SE 1540 Fox St
Delano,MN 55328 Wayzata, MN 55391
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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�" f'1PPLI('ANT PERMITEE SIGVATURE ISSUED[3Y SIG:VATURE
Copies: 1-File(Sig�iatures Required�, I-Applicant, 1-Monthly Rcports, 1-Assessing,([f Septic, 1-Septic) Page 1
1 .
,�p� City of Orono FOR CITY USE ONLY
P.O.Box 66 C/
��.t,.,,, � 2750 Kelley Parkway Date Received: ��/' O� Permit#�' ��S� T
� ��y�-.� � Crystal Bay,MN 55323 ��
����'�%M1p4�o` (952)249-4600 Amount: $ S� -�
CITY OF ORONO — SEPTIC SYSTEM PERMIT APPLICATION
(All permits must be approved by the On-Site Septic Manager and/or Building Official)
� Job Site / Owner Information:
Site Address: � j � �' �^ � :�, ` �
Owner: Mailing Address:
City: (�' ►��� �. �-:, Zip:
Home Phone: Alternate Phone:
Contractor/ Applicant Information:
r
Contractor/App.:_ f_--�r+�ti ;_,t � .- A t GC� , Contact Person: � '. �- �� ' `���r� �,
Address: J `%" � � Qc,�. �.� r s!,�d.�'�' S'f State License #: „2 � J
City: �.�: �c. � ,�, Zip: � `� ,�2� Expiration Date:
� r. ,. r r�. �
Phone: � ��� �� ,�� � . � "' Alternate Phone: �wc;•��,� '" � ,.5`;'
�
'`" TYPES OF OCCUPANCY
� Residential ❑ Commercial ❑ Other
PERMIT TYPE AND FEES '
New or Replacement System $100.00
��� Q
���epair Existing System 50.00 ,5�: Dd
��� (Tanks or Drainfield)
`State Surcharge .50 .50
��Total � � .�
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� ** ATTENTION APPLICANT **
'� Fill in all appropriate blanks and check all appropriate boxes.
I will be installing the following:
Tanks
� Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other
(list manufacturer)
Number of Tanks: G r, t
Size of Tanks: /6 � C"�
Treatment System
Trenches s.f. �
Mound s.f. - �
/�,I�
Gravel less s.f.
� �
Chamber s.f.
Final Cover/ Top Soil
to be borrowed from site (show location on site plan)
trucked in
The undersigned hereby applies to the City of Orono for issuance of a septic system
installation permit, agrees to do all the work in strict accordance with ordinances of the City
and regulations of the State of Minnesota and certifies that all statements made on this
application are complete, true and correct.
Signature of Applicant �� Date: �� �G -��
MPCA License No.: __`,� � �
Staff Review: `"�J Accept ❑ Denied
� �
Reviewer: , Date: � - l0 ' C��
Reason for Denial:
Comments (to be printed on inspection card):
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