HomeMy WebLinkAbout2013-00745 - sewer disconnection '� ' CITY OF ORONO * z 0 1 3 — fd 0 7 4 5 *
2750 KELLEY PARKWAY DATE ISSUED: 07/3U2013 r
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1421 NORTH ARM DR
PIN : 07-117-23-44-0073
LEGAL DESC : HIGHWOOD LAKE MTKA
: LOT 000 BLOCK 000
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DISCONNECTION
NOTE: SEWER DISCONNECTION
SEWER-4"PIPE-SCHEDULE 40
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
KNAPP& SONS SEPTIC STATE SURCHARGE SEWER&WATER 5.00
13574 110TH STREET
MILACA,MN 56353- MAIL-IN FEE 2.00
(763)477-8566 TOTAL 57.00
PAID WITH CC# 3168
OWNER
NORMAN,THOMAS
1421 NORTH ARM DR
MOUND,MN 55364-
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 Building Code. This permit is for onty the work described and does
not grant permission for additional or related wark which requires sepazate
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 commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoJced at any time for due ca se.
� , j �, � ��l�
p ican Permitee Sig ure Date ssu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
Jul 31 13 06:45a Knapp and Sons Septic LLC 320-369-3795 p.1
CIT USE UNLY
Z�U/Vr) City ofOrono DateReceived� ?,Perroit#�� 7�5
P.O.Box 66
!\� 2750 Kepey Parkway ❑In-Housc SAC Determination Forn Completed
, ,,\ i , , Crystal Bay,MV 55323
���'�,,� (952)249-4b00 Approved By(If Required}:
CITY OF ORONO-SEWER&WATER/GENERAL PERMT�
(k lYote:Some pecmits may require appioval by che Building O�cisl and/or Public Wo[ks Department s)
G1LL PERMf15- Mav be subiect to f�rdrer revicw and mav not be issaed w•�e�Ihe:oolicatiu���'+ce4i_vcd.)
GENERAL INFORMAI"ION
t. You may apply for utility permit�by mai]or in person at the City offices,
2. Mailed in applications are subject to the postage and handling fee shown beiow. Permit cards will
be sent by return mail within 2 business days.
3. Perroits are not valid ontil you receive a permit card.
4. Work must not begin unless the permit card is availabie on the job sice.
5. Utility connection permits rnay be issued to licensed contractors only.
6. Contact the Public Works Department(952-244-460Q)for utility stub as-built locations_
DO NOT EXCAVATE IN ANY 9TREET AND DO NOT TAP ANY MAIN withoat express
approval of We Public Works Department. lssuance of a per�nit does not grant this appmval.
7. All work must be done in accordance with State Code requircxnerrts.
8. AEl work must be inspected before it is covered. Call(952)249-46(}0,24+hour notice required.
TYFE OF PERM[T
Check Atl That A 1
❑Residential(I�iay Require Approval) ❑Commercial(Approval Require�
❑New Cormection ❑Additional Connection �Re-Connection ❑Repairs �Disconnect
❑ Water Availability Connection For Future Nook-Up to Water
Job Site/awner Information:
Site Address: ��a� �C1�`�"�� //rt� ����ve
Owner: �f Y co,�sfirv�tro., Mailing Address: � � �� ��r%.-, �., �-'j,�
City: �%'��t� � / Zip: ��y�//
Home Phone: Co�� -y 1�U- �/�( Alternate Phone:
Contractor Information:
Contractor: �� o..s �'�ontact Person: �- �
Address: ��5�7y /�v� �S� Stai:e License#: ]��(o �G�
City: �'/G�� Zip:/�/'�'Expiration Date: �� ,3� o�G'� 3
Phane: %�.3��/7 7--���� Alternate Phone: 3.�0-3� y-3��1
Jul 31 13 06:45a Knapp and Sons Septic LLC 320-369-3795 p.2
DETERMiNING PERMIT FEE5
0 SAC Charge(2013 Rate=�2,435.00) S
(SAC Charge must accompany a[1 sewer permit applications unless�rep�aid)
(Orono City Staffcan determine if applicable}
(If not prepaid,a sewer connection permit wi[I not be issaed)
ewer Conn 'o isconn Repsir(SSO.00/Per Stub) $ �(�(�.. G�(}
Pipe size,__inches;material�Schd 44 sir tested; cast iron
❑Water Conoection/Disconuect 1 Repair($SlI.U0/Per Stub) S
Pipe size inches;materia] Schd 40 air tested; copper -
❑Water Availability For Future Hook-Up to Vl�ater(S50.00) $
Water Availabilitv Ezalanation:
Contractoc installed line to inside of house for fuiure hook-up.
This lirte will be inspected by the Public Works Department,
Reauired Sefore Water Conn�tion Permit is Issued:
l. Issue R+ater Meter&Hom PermiY .
2. Any Additional Cocuiection Fees Paid(If Applieab(e)
Tssue Water Connecfion Permit:
1. Collect Permit Fee&Issue Water Connection Permit
1. SUBTOTAL of Permit Requested: S �V U . C��'1
2. STATE SURCHARGE $ S.UO
3. POSTAGE&HANDLING(Only on Mail-In Appiications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) s '�/ C9 7`. G G4
ADDITIONAL INFORMAT[ON—WATER METERS
■ WA'I'ER METERS must be picked up and paid for at Orono City Halt,these are on a separate permit.
• WATER METE1tS musf be set aod sealed by Orouo Water Department (952)249-4G00, upos
completion of roeter installation.
The undersigned hereby applies to the Ciry of Orono for issuance of a UtiIity Permit,agrees to do
all work in strict accordance with the ordinances of the City and the regulatioas of the State of
IvTinnesota,and certif that all statements made on this apptication are,t�ue and correct.
-,
�
i
Applicant• :'� � Date• � �/ �,j
Jul 31 13 06:45a Knapp and Sons Septic LLC 320-369-3795 p.3
ry • . �
T
SEWER&WATER PERMIT
IN HOUSE FORM-TO HELP DETERMINE SAC UMTS
FOR CITY USE ONLY
(�Please Key Thia[nformation On Commeat Linc Of Permit*)
Date Completed: #Of SAC Units Completed By:
❑ *SAC Previouely Paid- Permit# Date otPermit
"Charge t SAC Unit Per Home
•If Multiple Homes Or Units-May 1Veed To Pay Additional SAC Charges
❑ *SAC Grandfathered In— Permit� Date of Permit
'Must have had Hook Up&Home Prior To January t,1973
'Refer#a Helpful I-Iint Sheets,Or Ask If Necessary
'IfMulripk Units-MayNeed Ta Pay Addilional SAC Charges
❑ *Canmercial— Permit#Aceountcd Far Date of Permit
� xLetter From lviet Co�ncil—Showing LJse-Or Additional Units I�Teeded-
"Contact Jodi ai(65 l)602-I]l3 Ta Obtain[.ctter(Usually Building OtTcial ObOdins)
*Copies To:Lyle,Street File&One On Copy df Permit Por Reporting
"Ifunable to determine;will have to wait to be issued until detertnination can be made
❑ SEP'I'IC Area- ***WATCH FOR THFSE CONNECT[ONS"•'
"Person W71 Have To Pay Connection Fees&Assessments+SAC Charges
'"Refer To Cunent Year Fce Schedule! Don't Release Until Fees Are PAID!
(Ask for Scori or Lin's Help With T'hese)
"Will Ne�d Approval Fmm Public�Vorks(Scott)
❑ Special Grinder Pump Needed
'Hati•e Them Talk To Scott For Questions&PriCing
"Give Them Special Hand Outs!(In Drawer With Sewer Pertnit}
[] Permit Needs Approval From Public Works: Approved By:
`Side note,Connection Permits—Cover Septic Tank Abandonment Also,Per Lyle
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�---- v DATE TIME ✓
CITY OF ORONO CALLED IN � �
INSPECTIO�,,lVOTICE r/ SCHEDULED � �
PERM;T NO.ad13�'DD77'� COMPLETED
ADDRESS iya i /UD'7"���1 � �
OWNER TE,L�EPHONE N0.763 ��7 �5�(�
CONTRACTOR ��� ���,In � C-
j; DESCRIPTION ���� (J �S���
�
� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICALRI � LAKESHORENVETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL
❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPIAINT
J ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
i ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO �
� CO MENTS: Y � ,''d�'I � -P!i /� z
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W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR W4LL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REOUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� 249-4600
OwnerlContractor on site:��� �C-
Inspector.
White Copyllnspector's File Canary CopylSite Notice