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Home My WebLink About2009-00846 - sewer pass through T • � �� ' CITY OF ORONO PERMIT NO.: 2009-00846 2750 KELLEY PARKWAY ORONO, MN 55356- nATE ISSUED: 1 U25/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 30 MYRTLEWOOD RD PIN : 36-118-23-33-0011 LEGAL DESC : MYRTLEWOOD : LOT 003 BLOCK 001 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL COI�TSTRUCTION TYPE : CBTd��BN L-�f>;��7r��u,�-.,�} 1'-� cit y- .�f u�•�tr,,; �75G Kelley F'drh.s�ay Drona MN 55,;�6 95�-�4'3-4E,i?U NOTE: Recei t NOt .'S.�0178� r�= -tlr1r. THIS IS SAC&WAYZATA SEWER CONNECTION FEE FOR PERMIT#2009-0084; P �'�v ��. r.__ �t'UC8 PdU�Si�f� PAID WITH CHECK#4731 Permit=_. �Ud9-Grr�;�� -� �:;yrt' - _ -.. Rd ;e4v:::_;�, _�,'" ,�:: 1(il-�U8U9 5� Charges due to MW��.4 Per�its �(��9-G0846 30 Myrtlew�_,:;�_ :,�_;.�:_.;; Rd i{,i-�aso� Wayaata Wtr/Swr C�nnertior� ;-e� TU 4 d i i --._.__._...__c....=._ c,5c��:.. �tr�ck --=______>; Check No: 4731 � �il,_,;-; "ayor: ' Bruce Paulsan ?c:tal Applied: �,5��. -: ----- --__ . Ch�r�pe Ter�dFrrc: APPLICANT PAULSON, BRUCE&LORI S.A.C. 2,000.00 30 MYRTLEWOOD RD SEWER CONNECTION CHARGE-WAYZATA 525.00 WAYZATA, MN 55391- TOTAL 2,525.00 OWNER PAULSON,BRUCE&LORI 30 MYRTLEWOOD RD WAYZATA, MN 55391- 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 Buiiding Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances goveming this type of work shall be compied with whether or not specified 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 wmmenced. The applicant is responsible Yor assuring all required inspections are requested in conformance ' the State Building Code.This permit may be revoked at time ca � �/—�� 9 � Cr��f� � � / / / / ica rmitee Signature Date Issued By ignature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. , . . . �� FOR C Y E ONLY 0,��,0 City of Orono Date Received: � it# dDo g- 8s� P.O.Box 66 �„� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed �� e*Crystal Bay,MN 55323 N ,:� ��,�- �� ' � �";�..�o� (952)249-4600 Approved By(If Required): �gL§gp8 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 aoplication 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. Urility connection permits may be issued to licensed contractors only. 6. Contact the Public Works Deparhnent(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 pernut does not grant this approval. 7. All work must be done in accordance with State Code requirements. 8. All wark must be inspected before it is covered. Call(952)249-4600, 24+hour notice required. TYPE OF PERMIT (Check All That Apply) esidential(May Require Approval) ❑ Commercial(Approval Required) ❑ New Connection 0'�itional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: j�� -�✓��'I �� 1-�" ��4� j��9�l1� Owner: �/�f �iL�_.� ��7�1�C� Mailing Address: ��1�l��' City: �/ �f ��f' Zip: _�d�� ✓�7 !� Home Phone: CI�Z �/�'� /�2 2/ Alternate Phone: �S^2 r �� 3 �� Contractor Information: � Contractor: Contact Person: Address: State License #: City: Zip: Expiration Date: Phone: ' Alternate Phone: . � • �� (^ • '' ,� �-��; ,� 1,° /�(/`�/Z _,-l/�i?f i�.//1�( ; �r .'e' .`r- �' .n _ .. ��; DETERMINIl�IG PERMIT FEES ❑ SAC Charge(2009 Rate=$2,000.00) $ UaO, d �/ (SAC Charge must accompany all sewer permit applications unless prepai (Orono City Staff can determine 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 ❑ Water 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 Explanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Required Before Water Connection Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connecrion Permit: 1. Collect Permit Fee&Issue Water Connection Pernut 1. SUBTOTAL of Permit Requested: $ ��J� � Q 2. STATE SURCHARGE $ .50 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ O�J�v�J�� ADDITIONAL 1NFORMATION—WATER METERS • WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate pemut. ■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon completioi�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 certif that all statements made on this application are, true and correct. Applicant: Date: // ��"