HomeMy WebLinkAbout2007-P11626 - sewer disconnect PERMIT
,CIT'Y OF ORONO
�750 Kelley Parkway- PO Box 66 Permit Number: p11626
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
l 0/29/2007
SITE ADDRESS: 4175 Highwood Rd Unit#
Mound,MN 55364
P��� 07-117-23-44-0021
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Pcrmit Sub-type(s): Sewer Disconnect
DETAILS:
Approved per resolution#:
Separate permits required: Other-(SAC Grandfathered In#2828-08/18/71)
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Farr Construction OWNER: Merlin Halverson
100 Bridge Ave 4167 Highwood Rd
P.O. Box 277 Mound MN 55364
Delano,MN 55328
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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� AP LICANT PERMITEE SIGNATURE ISSUE Y SIGNATURE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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FOR CITY USE ONLY
/,���.� City Of�ConO Date Received� Permit#
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��� ��� P.O.Box 66
�,Gs y 2750 Iielley Parkway ❑In-House SAC Determmat�on Form Completed
'�� �� �<�":. �hf Crystal Bay,MN 5�323
���{���}.,�G`/ (952)249-4600 Approved By(If Required):
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CITY OF ORONO—SEWER & WATER/GENERAL PERMIT
(*Note�Some permits may require approval by the E3uilding Official and/or Public Works Department*)
(ALL PERMITS- Mav be subiect to further review and ma�°not be issued when thc auplication is received)
GENERAL INFORMATION
1. You may apply for utility permits 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 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 express
spproval of the Public Works Department. Issuance of a permit 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 ootice required.
TYPE OF PERMIT
(Check A11 That A 1 )
Residential(May Require Approval) � Commercial(Approval Required)
� New Connection ❑Additional Connection �Re-Connection �Repairs �Disconnect
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Job Site/Owner Informati�n:���4 ��
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Site Address: `�1�� '��� 7 � �� f � j�c�� ��;r�;� �C;�
Owner: �`'Ic�^ �f� 1—�G��1:L:4^x� Mailing Address: �_, ��C:;
City: �� ���v����', I �1 , �)� Zi � 3
P� 5S I�,
Home Phone: Alternate Phone:
Contractor Infonnation:
Contractor: �C�4"�'' C.L,f/15'� Contact Person: �►r-cik ����r
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Address: :��% �I�t�S �Jn�c State License #: ,,L � � �
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City: ��(c�vt�;� Z�p: •,;5� Expiration Date: (�1_— .�GC, `�
Phone: 7�3- y 7:,� '�(�G� Alternate Phone: �� � � 7C�( � �( 7 Z?I
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� SAC Charge(2007 Rate=$1,675.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono Ciry Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
�Sewer Connection Disconnect $35.00/Per Stub) $
Pipe size inc , �al Schd 40 air tested; [� cast iron
❑Water Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; � copper
1. SUBTOTAL of Permit Reyuested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines ]-3 Above) $
ADDITIONAI;INFOI�MATION—WATER"IvI��'ER�'
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate permit.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of ineter installation.
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,true and correct.
Applicant: ��1��1 Date: /U � �� - � �
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