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Home My WebLink About2012-00019 - sewer/water disconnect ,� �` CITY OF ORONO PERMIT NO.: 20�2-000i9 2750 KELLEY PARKWAY ORONO, MN 55356- DA'rE ISSUEn: OU10/2012 952 249-4600 FAX: 952 249-4616 ADDRESS : 3572 LIVINGSTON AVE PIN : 17-117-23-43-0150 LEGAL DESC : NAVARRE HEIGHTS : LOT 000 BLOCK 003 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTf: WATER AND SEWER DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 MIKIES LANDSCAPING WATER CONNECT/DISCONNECT/REPAIR 50.00 11039 COLINTY RD 16 WATERTOWN, MN 55388- STATE SURCHARGE SEWER&WATER 5.00 (612)221-3657 TOTAL 105.00 OWNER CUFF, MARK& KAREN 3572 LIVINGSTON AVE WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specitications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant pennission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not speeified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction 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 reques[ed in co formance with th State Building Code.This permit may be rev� t an me f ue ca � �. � / / / l /O l /d-- Applicant Permitee Sig a ure Date ssued y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. . � . /��ov FO IT GSE ONLY G�' ¢Q� City of Orono Date Received: ern�it# �� ' dd�/ P.O.Box 66 ��„.� � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed � ��f�,�� F Crystal Bay,MN 55323 /�� '��.yo (952)249-4600 Approved By(If Required): CITY OF ORONO-SEWER& WATER/ GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aaalication 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. Pernut cards will be sent by return mail within 2 business days. 3. Permits are not va(id until you receive a permit card. 4. Work must not begin unless the pernut card is available on the job site. 5. Utility connection pernuts may be issued to licensed contractors only. 6. Contact the Public Works Department(952-249-4600) for utility stub as-built locarions. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a pernut 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. TYPE OF PERMIT (Check All That Apply) ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) ❑ New Connection ❑Additional Connection ❑Re-Connection ❑ Repairs �Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/ Owner Information: � Site Address: �� U� �� S/ U/1 1��iZ Owner: i�C'-i� C �Ty Mailing Address: City: � f2 C>n C% zip: Home Phone: Alternate Phone: Contractor Information: Contractor: ��K,G S ��Sc�.�; Contact Person: �� .Cy� � Address: ��0 3�1� G i/ %�t� �� State License#: City: ��i/zQ/c-L-� M�Zip: S��ExpirationDate: Phone: �r��- �� 3��7 Alternate Phone: �J`�� - �i��' �J 5�..� • . . ' ❑SAC Charge(2011 Rate=$2,230.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staff can deternune if applicable) (If not prepaid,a sewer connection permit will not be issued) ,�Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ �� Pipe size inches;material Schd 40 air tested; cast iron �ater Connection/Disconnect/Repair($50.00/Per Stub) $ �� Pipe size inches;material Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Egnlanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Required Before Water Connecrion Permit is Issued: 1. Issue Water Meter&Horn Pernut 2. Any Addirional Connection Fees Paid(If Applicable) Issue Water Connection Pernut: 1. Collect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ ��o, v C� ,� 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $_�!�(1 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �DLJ � � �' �� .,� �R�Y��`€+OI�I`-�'�?�.�.�'�'-T�W�1Y�� ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate 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 s tements made on this application are,true and correct. Applicant:� � Date: J —l� '��