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Home My WebLink About2010-00558 - septic repair � CITY OF ORONO PERMIT NO.: 2010-00558 � 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 07/07/2010 952 249-4600 FAX: 952 249-4616 ADDRESS : 4740 NORTH ARM DR W PIN : 06-117-23-23-0009 LEGAL DESC : LJNPLATTED 06 117 23 : LOT 000 BLOCK 000 PERMIT TYPE : SEPTIC PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : REPAIR APPLICANT SEPTIC REPAIR 100.00 MARTYS EXCAVATING STATE SURCHARGE SEPTIC 5.00 �/ 7185 RUTZ LAKE ROAD MAYER,MN 55360 TOTAL 105.00 (952)657-2548 Minnesota State License#: 768 OWNER HEDBERG,JOHN&JANICE 4740 NORTH ARM DR W 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 only the work described and does not grant permission for additional or related work which requires sepazate permits. All provisions of laws and ordinances goveming this rype of work shall be compied with whether or not speci£ed 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 revoked at any time for due cause. c�� c .�F�J7�.t/..,�2 Z,.�=s.�. �-�— �/ 7 / ,us IO l l plicant Permitee Signature Date Issued By i ature e SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOV . .r"' � � � g0� City of Orono FOR CITY USE ONLY 0 t\ � P.O. Box 66 �,4 2750 Keliey Parkway Date Received: Permit# � 1�'��. t� Crystal Bay, MN 55323 ��.,,�;o,��,�� (952)249-4600 Amount: $ � CITY OF ORONO - SEPTIC SYSTEM PERMIT APPLICATION (All permits must be approved by the On-Site Septic Manager and/or Building Official) Job Site'�C)�ntr�e��n�� i ��m � ,��. ��.. .��.�� Site Address: `f' � �(� 1'U��-��, ��h, /,7�- V�� Owner: ��'��1/�" l�� ,� e�- � Mailing Address: � City: `1�G`J n C� zip: 5 S 1� �I Home Phone:�;�',;�--- y 7� - .�� `�' Alternate Phone: Contractor/Applicant Informatian: ��"��;� Contractor/App.:��J'1�,,;�� x c:�,;,�, �, ;��, Contact Person: ��1�1�vt�; Address: 7/,� 5� ��Z �2 is� �?�� State License #: 7�� C�' City: 1�7�{ � Zip:, S 5 ��G�=' Expiration Date: �._�/D�/;Z�� Phone: `��5 a�- �ST - �..5�'�i`�' Alternate Phone: � ��-��E � � �>�/ c,�j� ��M � � �� .�.}R� .��,�r ?��. .�� ,°�.,:� ,. TYPES OF �CCUPANCY ., : --� [� Residential ❑ Commercial ❑ Other � ,, � �� . ..s...�� "Y �.:a� �r,�� "�� .°. �REF�MIT�;��YPE.AND.FEES��. , �,; � ,,� �`�� E � New or Replacement System $200.00 � Repair Existing System 100.00 � DD. D 0 (Tanks or Drainfield) State Surcharge 5.00 5.00 Total $ W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc 1 / 2 "� . � ** ATTENTION APPLICANT ** ' Fill in all a ro riate blanks and check all a ro riate boxes. I will be installing the following: Tanks � Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other (list manufacturer) Number of Tanks: �-� Size of Tanks: ,��'��i� �� /��o�� l �' G,,� � �c�� a baC Treatment System Trenches s.f. _,� Mound ��--�{" . s.f. Gravel less s.f. Chamber s.f. NOTE: The contractor is required to provide an As-Built of the system before the final inspection. The undersigned hereby applies to the City of Orono for issuance of a septic system installation permit, agrees to do all the work in strict accordance with ordinances of the City and regulations of the State of Minnesota and certifies that all statements made on this application are complete, true and correct. Signature of Applicant�� c�:�,,... /�� c�e-��„�� Date: 7 �� --�� MPCA License No.: 7� �� Staff Review: �Accept ❑ Denied Reviewer: �( ,c ,��I.,L, �� Date: �� S �,,�U � C; Reason for Denial: � Comments (to be printed on inspection card): � x•- S t-- iJc.� ;1i.� ,� �1✓��< �—Z:� � W /-� �--�' .�I_ � `� .T /�� W:\(Permits)\Septic Permit Application-Updated Surcharge 7-1-10.doc 2 � 2 � J D T TIME � CITI�O�ORONO CALLED IN 8 �� INSPECTION NOTICE ¢ SCHEDULED ' 7—� � PERMIT NO. o�OID�QOSSO COMPLETED ADDRESS �7�0 � �� • OWNER TELEPHONE NO.��Z S�pg OSB� CONTRACTOR r�«� >; DESCRIPTIDI�I �G��S � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS � ❑ FRAMING ❑ MECHANICAL FINAL O ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP ? ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a � � �� (�'!� 1 1 C�� `7' 1'``�' � L'�%'/�p��T ��c�lr/l� � - � !1 � -- ��1 u�� Q _ �`'� r --�---�,r' ��l ��--. � �� z w � � � �� j �c1 ✓�t�c� i��1 �,j,o,�.- � ❑WORK SATISFACTORY:PROCEED ROJ ECT COM PLETE `�.J�—' W ❑CORRECT WORK&PROCEED G IS E CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CAIL INSPECTOR ❑ INSPECTION REQUIRED.CALI TO ARRANGE ACCESS. Cali for the next inspection 24 hours in advance. (J52� 249-4600 Owner/Contractor on site: Inspector. `j White Copyllnspector's Fite Canary CopylSite Notice