HomeMy WebLinkAbout2009-00921 - sewer connection CITY OF ORONO PERMIT NO.: 2009-00921
�- 2750 KELLEY PARKWAY
ORONO, MN 55356- DATE tss�En: 12/3U2009
952 249-4600 FAX: 952 249-4616
REPRINTED ON 12/31/2009
ADDRESS : 50 MYRTLEWOOD RD
PIN : 36-118-23-33-0006
LEGAL DESC : REG. LAND SURVEY NO. 0446
: LOT 000 BLOCK 000
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENT[AL
CONSTRUCTION TYPE : PASS�'OUfa�I'F'EES GJ�/�,y�Q�G�'�1�
NOTE: THIS IS THE SEWER&SAC CONNGCTION FEE FOR PL;RM["C#2009-00923
PAID VIA: STEVEN CHAMPLIN,OWNER
APPLICANT SEWER CONNECTION CHARGE- WAYZATA 525.00
CHAMPLIN, MR.& MRS. S.A.C. 2,000.00
50 MYRTLEWOOD RD
WAYZATA, MN 55391- TOTAL 2,525.00
OWNER
CHAMPLIN, MR.&MRS.
50 MYRTLEWOOD RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
7he work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and dic
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 goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become nuli 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 atter work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may bc
revoked at any time for due cause.
/ / / /
Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
�
C_�it_y of �Ono
z750 Kelley ParkMay City of Or�r�
Orono MI 55356 952-249-4b04
�7Jlj Ke21ey Parkway
Receipt No: 3.001914 Dec 31, 2409 Ororro �pI S,;�E, g�-�49-464U
Steven Chaeplin Receipt tVo: 3,pG�c�S �tar� U4, c�?1U
Stever� Charnplin
Per�its
2009-0092'2 50 Myrtlew+ood 1,920.00
� Perra i t s
101-20807 �djU-'t�U1:9 5U Myrtlewovd 36.OtJ
Wayzata Wtr/SMr Corx�ection Fee lUi-�U8U7
Per�its
�-00921 50 Myrtlewood 525.00 Wayzata Wtr/5ar Cunnectior� Fee
Perrnits
101-20807 �Ult1-GU1�U SG Myrtlewaod 1U0.�i
Yayzata Wtr/S�m Com�ction Fee �d
P�its 141-�UBC�7
Z009-00921 50 MyrtleNood P,000.00 i�ayzata Wtr/Sar Cannection Fee
�� Tatal: -�---
101-20809 1�U.Gu
5RC Charges due to MAiCC Check =_____=___
Total: 4,445.Q0 Check No: 19418 1,sU.�4
Gayr�Y';
�eck Stever� Charnplin
Check No: 19374 4,445.04 T�t31 Applied:
Payor: ------:3U_00
5"teven Cha�plin Change Tendered; UQ'
Total Applied: 4,445.� �_________
Change Tendered: .00 43/U4/SO G2:45Gip
12/31/09 09:55AM