HomeMy WebLinkAbout2009-00770 - sewer pass through , CITY OF ORONO PERMIT NO.: 2009-00770
` 2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE IssUEn: 10/29/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 45 MYRTLEWOOD RD
PIN : 36-118-23-33-0015
LEGAL DESC : MYRTLEWOOD
: LOT 003 BLOCK 002
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE . ��.(�`_> �����j���,4[`�-� �
City af Orarra
2750 Kelley Parkway
NOTE: THIS IS SAC&WAYZATA SEWER CONNECTION FEE FOR PERMIT#2( �� � 5� �-�4��
PA[D WITH CASHIERS CHECK#731502405 ReCeipt I�: 3.�16�6 ikt 29, P�9
lessica 9rown
Per�its
2009-Od77d - 45 Myrtlewo 5c5.0(?
ad Rd
141-20807
Nayzata Wtr/5w�^ Conr�ection Fee
Ger�its
2U09-00770 - 45 Myrtlewoo 2,U06.OQ
d Rd
1G1-248G9
SAC Charges due to M�C
Tatal: �,�•�
Check
Check No: 73150�4U5 2,525•UO
Payor:
Jessica Bram
Total Rpplied: �,�•�
APPLICANT SEWER CONNECTION CHARGE-WAYZATA 525.00
BROWN, JESSICA
45 MYRTLEWOOD RD S.A.C. 2,000.00
WAYZATA, MN 55391- TOTAL 2,525.00
(952)476-2575
OWNER
BROWN,JESSICA
45 MYRTLEWOOD RD
WAYZATA, MN 55391-
AGREEMEIVT 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 Building 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 governing 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[ime after work has commenced.
The applicant is responsible for assuring all requiced inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
/ / / /
Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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m � E FRONi OF T/{E DOCUMENT 11AS q MI('Hn pq�N�'y()H�FIi �f3SEN(,f()h-THESE FEATURES WiLL INUIf,AiE q�;��„�
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(� � ` No. 731502405 �
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�I � 1. � TWO THOUSAND FIVE HLINDRED TWENTY FIVE DOLj,qRS AND 00 �ATE: OCTOBER 27, 2009 �
� , CENTS �
TO THE �•
� oROER oF: CITY OF ORONO � 2�525.00 �--
� PURPOSE/REMITTER:dESSICA BROWN �
� Location: �
� � 731 WqyZATA �'
U.S.Ba��k National Association
� d Mimxa�lis.MN 55480 _
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� _.. AUTHORIZED SIGNATURE �
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,, OF ORONO
/b �> l.} ' P.O. BOX 66
y �� G, TE�EP oNE Y'MN 55323 GENERqL RECEIPT
y �� � � 473-7358
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��� City of Orono �Da�Reoeiv�ed.� em��t#����.""_d� 7�°�'
P.O.Box 66 `��'�'
�" � 2750 Kelley Parkway 0 Sn-Fiouse SAC Determination Form.Completed
� � ;, � Crystal Bay,MN 55323
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(952)249-4600 Approveti By('IfRequirec3): `
CITY OF ORONO—SEWER&WATER/GENERAL PERMIT
(*Note:Some permiu 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 aoalication is received)
GENERAL,3i�1Ft�1ZM�TT�N';
1. You may apply for urility pernuts by mail or in person at the City offices.
2. Mailed in applicarions 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 pernuts 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 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 notice required.
TZ'PE�F�'��'IT:
(Ghec`k�,11�iat:A �?1' j `
❑Residential(May Require Approval) ❑ Commercial(Approval Required)
� New Connection ❑Addirional Connection ❑Re-Connection ❑Repairs ❑Disconnect
� Water Availability Connecrion For Future Hook-Up to Water
J�ib�'�1�e��vvrier Iriformation.
Site Address: y Mv�'���.��,� R.D
Owner: "3QS�`ce� Q�Pats/1 Mailing Address: ��/���\w�nt�
City: Orc7r�L� Zip:
Home Phone: �S�l.-��(�-��7�. Alternate Phone:
Con�r•actor=��orma:tion: � ',
Contractor: C T�:� 5`..�t' c W:��l�e� Contact Person: Q:�\ c�.�`•��_
,
Address: ���1 �,�i� ��� State License#: �7��;`�J�1R
City: �:4ec}�„� Zip:�3� Expiration Date: �'�-3i-04
Phone: q��y SS- �S`c3�3 Alternate Phone: �\�- 508��`��`�1