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2016-01286 - sewer & water connect
CITY OF ORONO * Z 0 1 6 - 0 1 2 8 6 * , 2750 KELLEY PARKWAY DATE ISSUED: 10/1U2016 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 758 BRIDGEWATER DR PIN : 33-118-23-I1-0133 LEGAL DESC : STONEBAY FOURTH ADDITION : LOT 16 BLOCK 1 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTIOIY TYPE : CONNECTION NOTE: CALL FOR INSPECTION WITH PUBLIC WORKS AT 952-249-4600. SAC PAID#2016-01269 09/26/16 APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 WATERCONNECT/DISCONNECT/REPA[R 50.00 BOLLIG&SONS, INC. STATE SURCHARGE SEWER&WATER 1.00 11401 COLINTY ROAD 3 HOPKINS,MN TOTAL 101.00 (952)938-4433 Payment(s) CREDIT CARD 6881 101.00 OWNER Stonebrook Development LLC 17149 LINCOLN ST NE HAM LAKE, MN 55304- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State[3uilding Code. This permit is for only the work described and does not grant permission for additional or related work�vhich requires separate permits. All provisions of laws and ordinances govcrning this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction audiorized is not commenced within 180 days of the date of issuance,or if consVuction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at an time for due cause. �. �_ G�/ �� � I (� ��. .�..� /�K f��� i�' , l� , /h App icant Permitee Signature Date Issued By Signat re Date � 1. . FOR USE ONL ( ��� City of Oiono n�e Re�e;,rod: (�Perroit u C�/(D-�" � ��J'�O � P.O.Boa 66 ` ' 2750 Kelky Parlcway ❑k+-House SAC D�derminarion Focmc�p tetod ;�,(',� � crr�►sar,MN 55323 .`�C t'd �'l.ti (F.'C I �;���' '.9�.�F��� (952)249-4600/Fax(952)249--0616 Appimwed By(if Keqaiced): G� I� CITY OF ORONO—SEWER&WATER/GENERAL PERMIT (*Note:Somc permits may require appmval by the Building Official and/or Public Woiics Department•) (AI,L PERMITS- A7sv be subiect Go further review aad mav sot De issued wher t�e aoolication is reeeivedl GENERAL iNFORMATION 1. You may apply for utility peimits by mail or in person at the City offices. 2. Mailed in applications are subject to the postage and handting fee shown below. Pennit 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 ezpress approvai of the Pnbiic W orks Department. Issuance of a permit dces not grant this appmval. 7. All w�rk must be done in accordance with Siate Code requiremenis. K. All work must Eie ins�cted before it is covered. C:all(952)249-460(1,24+6our notice requirect. TYPE OF PERMIT (Check All That A 1 ) �Re:idential(May Require Approval j ❑Commercial(Approval Requirect} �.�Ic�i�Conncction ❑Additional Conncction ❑Re-Connection ❑Repairs ❑Disconnect ❑ Water Availabiliry Connection For l�'untre Hook-Up to Water � Job �ite i uwner InTortnation: � Site Address: ��(.� 1J��"�` �V���r Owner: r `������)� ���1 a e r.s Mailing Address: �)�� V���Z C►r ��( c�ty: �-���n►►�5 z��: S 5 3 f i 3 IIome Phone: �S�-3 C�Sy�5��� Alternate Phone: ! Contractor Information: � C;ontractor: V-��II�� � ��S (.`ontactPerson: I...��U1r �� ll� Address: I I C�`�� Cu �v � State License�: City: `I `��J Zip:JJ.��3 Expiration Date: r Phone: qSa' ��� r �) � Alternate Phone: j DETERIYIINIiVG PERi�IIT FEES j ❑SAC Chsr�e{'�416 Rste=52,485.Q4i � (SAC Charge must accompany all sewer permit apglications unless pre�aid) {Orono Cit��Staff csn�aetermine if•applicahit�'� (If not prepaid,a sewer connecrion permit will not be issued) �P�►�er CeRsePction�Disconnect!Repair{5'►O.00�Per Stah) 5 ;':r�s�ze inches;material Schd 40 air tested; cast iron �X l�;•at�r(�r���e_rti:�n%f)jcriennrrt%��n�ir iGi1i,1Hi%�+��r 4i��hi t--•- . 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