HomeMy WebLinkAbout2003-P06362 - sewer disconnect PERMIT
CITY OF ORrJNO Permit Number:
2750 Kelley Park�jay - PO Box 66 Po6362
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: s�2gi2oo3
SITE ADDRESS: 4140 Highwood Rd
Mound,MN 55364
PID: 07-117-23-44-0030
DESCRIPTION:
Proposed Use: Residential
Pernut Class: General
Pernut Type: Sewer and Water Pernut Pernut Sub-type(s): Sewer Disconnect
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 35.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Westonka Water&Sewer OWNER: James Cusack&Christine Grace
6501 County Rd 15 4140 Highwood Rd
Mound,MN 55364 Mound MN 55364
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICI'COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE [S ED BY SIGNATURE
Conies: 1-File(Signitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
CITY OF ORONU tirri.i�.tiljv�. 1'Vl\ V 11Li11 1 a�iu�aaa.+
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
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GENERAL INFORMATION
1. You may apply for utility pernuts by mail 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 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.
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 express approval of the Public Works Department. Issuance of a pemut 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.
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JOB SITE ADDRESS: �I`�� ) '_T�`�`��� �� '
Occupancy Type: K Residential Commercial
Owner's Name: Phone Number:
Mailing Address: City: Zip:
Contractor's Name: �7c �� �,�• � Phone Number: ��5.-?) y7.� -�/rd6
Mailing Address: S�� 4� /�'� [S City: �o uv��� Zip: •S�.�s�
PERMIT TYPE ❑Connections ❑Repairs �Disconnect (Check One)
SAC Charge (2002 rate $1,200.00) $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Co nectio ' connec epair ($35.00 per stub) $
pipe size�inches; material 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'
PERl�IIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per pernut must be
included for each well,sewer and water connection pernut requested.
3. Posta�e &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 work in strict
accordance with the ordinances of the City and the re�ulations of the State of Minnesota, and certifies that all statements
made on this application are complete, true and .or,�ect.
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Signature of Applicant: Date:
DATE TIME �
CITY OF ORONO CALLED IN .5��
INSPECTION NOT E SCHEDULED :5-1�'-03 /U'YS
PERMIT NO. � COMPLETED
ADDRESS � �� �c/Yl-
OWNER CONTR. h- w
TELEPHONENO. �-S� �7n� L/9CP lo
� DESCRIPTION �itSL�11h�.C�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMWG 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z U4 WALL BD• 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAIM
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
2 OWNERICONTRACTOR TO MEET YOU:_YES_NO
ti COMMENTS:
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W WORKSATISFACTORIFPROCEED ❑PRWECTCOMPLEfE
W ❑CARRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pH0T0 TAKEN
INSPECTOR WILL RETURN
�STOP ORDER POSTED.CALL INSPECTOR
0 CITATION ISSUED
❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Cau for the nex inspection 24 hours in advance. (g52) 249-4600
OwnerlContra i e:
Inspector.
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