HomeMy WebLinkAbout2007-P11475 - sewer disconnect PERMIT
Cll"Y OF ORONO
Permit Number:
�750 Kelley Parkway- PO Box 66 P11475
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
9/20/2007
SITE ADDRESS: 1376 North Arm Dr Unit#
Mound,MN 55364
PID: 07-117-23-41-0052
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer Disconnect
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Westonka Sewer&Water OWNER: William Bowen
6501 Co.Rd 15 1376 North Arm Dr
Mound,MN 55364 Mound MN 55364
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 BUILDWG CODE REQUIREMENTS.
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APPLI PERMITEE SIGNATURE ISSUED BY IGNATURE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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FOR�TTI'•U3E ON�.Y .
�,���� City of Orono DataReceived:� "�� Permit#,-
P.O.Box 66 �
2750 Kelley Parkway ❑In=Hnuse SAC DeterniinatiomForm Complete8 , ,:
�� � � Crystal Bay,MN 55323 `' ' '
� (952)249-4600 Approved By�(If Reguirad�:�
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 aoulication is received)
�GENER�L INF��NII�TI4�T
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
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.
' T'Y�'E�OF:PERIVIIT
Ch'�k�,�1 T'hat�, . 1
�Residential(May Require Approval) ❑Commercial(Approval Required)
�New Connection ❑Additional Connection �Re-Connection �Repairs �Disconnect
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Job Site/(Owner Int'arrnatinn:
Site Address: ! ��V /(�O/�� �f w� �/�
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information_'
Contractor: 1,�,�e��o�z�C yGJ Contact Person: �(`��o✓i C la.i'�
Address: �9��� �U- ��c��j �j State License#: ?��{/v�
City: (/V( Zip:S���Expiration Date: (�-3�-��
Phone: ���J U7�-Y Z�� Alternate Phone:�6i����l-S77 S
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�SAC Charge(2007 Rate=$1,675.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
�„Sewer Connec ' n/ isconnect Repair($35.00/Per Stub) $
Pipe size inches;material 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 Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
ADIDI'�I�NAL INFORMATiON-VVATER 1VIE�'�RS �
■ 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 statements made on this application are,true and correct.
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Applicant: Date: /���— ��
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CITY OF ORONO CALLED IN ��� ��
INSPECTION TIC� SCHEDULED �-� �
PERMIT NO. COMPLET
ADDRESS
OWNER CONTR. 2
TELEPHONE N0. —
� DESCRIPTION /�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEP IC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINA� 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOUf/ YES_NO
� COMMENTS:
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W WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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� ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
INSPECTOR WlLL RETURN
❑STOP ORDER POSTED.CALL{NSPECTOR r'CITATION ISSUED
G INSPECTION REQUIRED.CALlTO ARRANGE ACCESS.
Call for the nex inspection 24 hours in advance. (952� 249-4600
Owner/Contr, or n it :
Inspector.
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