HomeMy WebLinkAbout2004-P08173 - sewer connect � � PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P08173
Crystal Bay, Minnesota 55323 Permit Type: Sewer and water Permit
(952) 249-4600 Date Issued: iiiioi2oo4
SITE ADDRESS: 2625 North Shore Dr
Wayzata,MN 55391
P I D: 09-117-23-42-0003
DESCRIPTION:
Proposed Use: Residenrial
Permit Class: General
Pernut Type: Sewer and Water Pernut Pernvt Sub-type(s): Sewer Connection
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 Water&Sewer OWNER: Bartholomew&Elizabeth Butzer
6501 County Rd 15 2625 North Shore Dr
Mound,MN 55364 Wayzata,MN 55391
THE LJNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN Sl'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE ISSUED BY SIG ATURE
Conies: 1-File(SiQnitures Required), 1-AUnlicanL 1-Monthlv Renorts, 1-Assessin�, 1-Finance Page 1
(Updated 1/5/04)
CI'1`Y OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWERJWATER& SAC
Crystal Bay,MN 55323
GENERAL INFORMATION
1. You may apply for utility pemuts 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 rehun mail the same day
the application is received.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the pernut card is available on the job site.
5. Utility 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 pernut 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.
JOB SITE ADDRESS: �(9�� �U(��� S�t'��' l�� `
Occupancy Type: �, Residential Commercial
Owner's Name: ��.�"'� i3�tze� Phone Number:
Mailing Address: City: Zip:
Contractor's Name: .-fz���l��; �c,� Phone Number: �� L/7�- g6L�
MailingAddress:_ �,sp< <�� � , ,s City: ;�'��'�2°� Zip: �3��
PERMIT TYPE ❑Connections ❑Repairs ❑Disconnect (Check One)
SAC Charge (2003 rate $1,350.00) $ (Set Rate)
Sac Charge must accompany all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Connection/Disconnect/Repair ($35.00 per stub) $
pipe size�inches; material�Schd 40 air tested; cast iron
Municipal Water Connection/Disconnect/Repair ($35.00 per stub) $
pipe size inches; material copper; other
WATER METERS must be picked up and paid for at City Hall.
Water meters must be set and sealed by Orono Water Department
(952-249-4600) upon completion of ineter installation.
REQUIRED minimum setbacks from drain field and septic tanks = 75'
REQUIRED setback from sewer line= 20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per permit must be
included for each well,sewer and water connection pernut requested.
3. Posta�e &Handling(Only mail-in applications) $ 1.50 (Mail In Only)
4. TOTAL PERMIT FEE (add lines 1-3 above) $
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 complete, true and c rr t.
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Signature of Applicant: ��' Date: �I ' J� /