HomeMy WebLinkAbout2010-01142 - sewer disconnect CITY OF ORONO PERMIT NO.: 2010-01142
` 2750 KELLEY PARKWAY
` ORONO, MN 55356- DATE �SSUEn: 1U19/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 3095 NORTH SHORE DR
PIN : 09-117-23-32-0014
LEGAL DESC : REG. LAND SURVEY NO. 0670
: LOT 000 BLOCK 000
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DISCONNECTION
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
WESLEY BERDICKSON STATE SURCHARGE SEWER&WATER 5.00
6705 HIGHWAY 12 TOTAL 55.00
MAPLE PLAIN, MN
(763)479-1107 PAID WITH CASH 55.00
OWNER
COLE, RANDY
2959 LAKESHORE AVE
MEDINA, MN 55359
AGREEMENT AND SWORN STATEMENT
The worh for which this permit is issued shall be performed according to
the approved plans and specitications,applicable City approvals,and thc
State Building Code. This permit is for only the work described and does
no[grant permission for additional or related work which requires separate
permits. nll provisions of laws and ordinances governing this type of work
shall be compied with whether or not speeified 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 wnstruction is
suspended for a period of 180 days at an��time afrer work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conf�rmance th[he Sta[e[3uilding Code.This permit may be
r ed anyti e f��ause. r— • �i�� �{—�� �
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cant G ' gna re Dat Issued By Si ature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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�,¢p�� City of Orono ������i� ��,it� �=
P.O.Box 66 � ' ' � ' ��:
2750 Kelley ParkwaY �in I�cra5eSt#�I��te�ts��t�!Form�pra�tezi�_
��� Crystal Bay,MN 55323 ,, �
(952)249-4600 �,rpy�$Y��{'����
CITY OF ORONO-SEWER&WATER/GENERAL PERMIT
('�Note:Some permits may reqpire approval by the Building Official and/or Public Works Depamnent*)
(ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoolication is received)
GENER.��T:;�iI��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 rehun mail within 2 business days.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the pemut card is available on the job site.
5. Utility connection pemuts 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 eapress
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.
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.3' -�?-� $. � F� '�'�
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❑Residential(May Require Approval) ❑Commercial(Approval Required)
❑ New Connection ❑Addirional Connection ❑Re-Connection ❑Repairs ��nnect
❑ Water Availability Connection For Future Hook-Up to Water
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Site Address: �� ��i�t1( l ���� �,
Owner. �
`�l,l�� l�X�.�-- �1.�� Mailing Address: �5�2- �� �
City: Zip:
Home Phone:��D J '' �� ��.LJ-� Alternate Phone: (D�2 "7UQ - ��.�-�
Coritractt�r Tr��rni�tic�_
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Contractor � � n Person:
Address: �� State License#:
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City:/���� �11J Z��S1�` /`"xpiration Date:
Phone: �� 7����/ ���G'f Alternate Phone:
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❑SAC Charge(2010 Rate=$2,100.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can determine if applicable)
(If t prepaid,a sewer connection permit will not be issued)
ewer Connection isconn Repair($50.00/Per Stub) $ ��
Pipe size inc , terial Schd 40 air tested; cast iron
❑Water Connection/Disconnect/Repair($50.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; copper
❑Water Availability For Future Aook-Up to Water($50.00) $
Water Availabilitv Eaulanation:
Contractor installed line to inside of house for future hook-up.
This line will be inspected by the Public Works Department.
Required Before Water Connection Permit is Issued:
1. Issue Water Meter&Hom Permit
2. Any Additional Connection Fees Paid(If Applicable)
Issue Water Connection Permit:
1. Collect Permit Fee&Issue Water Connection Permit
1. SUBTOTAL of Permit Requested: $ �,IJ�J
2. STATE SURCHARGE $ 5.00
3. POSTAGE&HANDLING(Only on Mail-In Applicarions) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
� �� � �_ . h� A3?�I�'�OI�I.�L T,1�T�"URN,�T�QN: �1�iT�E�1�%tE`.PER:�
■ 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 hat all statements made on this application are,true and correct.
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Applicant Date: l