HomeMy WebLinkAbout2005-P09374 - sewer/water permit PERMIT
CIT� OF ORONO Permit ►vumber:
�750 Kelley Parkway- PO Box 66 P09374
Crystal Bay, Minnesota 55323 Permit Type:
Sewer and Water Pernut
(952) 249-4600 Date Issued:
10/31/2005
SITE ADDRESS: 3145 North Shore Dr vnit#
Wayzata,MN 55391
PID: 09-117-23-33-0013
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer&Water Disconnecric
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 35.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
Misc.Fee: $ 1.50
TOTAL FEE: $ 37.00
APPLICANT: Olson Construction Co. OWNER: Sveron Peterson
6970 Inwood Road 3145 North Shore Dr
Cologne,MN 55322 Wayzata,MN 55391
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 BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE SUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
Oct-25-2005 03:53pm From-CITY OF ORONO +9522494616 T-T06 P.001/001 F-889
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CYTY OF O�t,ONO-3EWEYt&'WATER/ GEN�YtAL PERMIT
(-Nota Somc permiu may roqu�re'irpr°val by che Suilding Officinl and�a Public W�ks Drpurrnxni')
�1_L Y'� M1'�'S- Msv be aubicc ru further ravi asd m v aat bE'+uucd w m the licatio is retEived
��'xB��-'��OR�VI,ATYON �� �,� . . :r ,. . . . .. . :.,
1. you may apply for utiliry permirs by mail or in person at rhe City offices.
2. Mailed in applicauons are subject to the postage and 1�ndling fee shown below. Pem1it cards will
be sent by rccum mail within 2 businesa days.
3. Permits are aat valid untII you receive 9 pe�mit card.
4. Work must not begin unless[he perntic Card is available on t�e job site.
5. Uriliry coanecrion perimts may be issued to]icensed conoractors only.
6. Contacc the Public Works Dcparnncnt(952-249-4600)foT utiliry stub as-builc locarions.
DO NOT EXCAVATE YN AN'Y STR�ET AND DO NOT TAp ANY MAiN withoat express
approval of the Public Works Department. Issuance of e peruuc dces nnc gram this approval.
7. All worl:must bz donc in accordance with State Code requirements.
8. All work must be inspected befvr�ir is covered. Call(952)249-4600,24+hour aocice required.
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�Residential(May Require Approval) ❑Commercial(Approval Required)
❑New Connection ❑Addiuonal Connecdon ❑Re-Connectioa ❑Repairs �Disconaect
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Site Address: �1�� � �r1C� l��i �P� ---
Qwner:�f'�yn��' ��'�' _ �(^� Mailing Address: I`J� C�.IQ(�(��R�
City: � _ �' -I�I� z��:
Home Phone: - Altemate Phone:
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Conixactor: �� �� Contact Person: �N (��SC�n
Address: ���� -�-n�%�� � State License#:�i��'� �6 r (',�',��
Cl�,. �� � Zip:��y��;�xpiration Date: N R •
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Phone: C/Jo� - �•. ` AltexnatePhone: �oi,��-�o�.-����,�
Oct-25-2005 03:53pm From-CtTY OF ORONO +A522494616 T-T06 P.001/002 F-869
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❑SAC Charge(2005 Rxte=SX,450.00) �
(9AC Charge must accompanY aII sewer permic applicauons unless prepaid)
(Orono Ciry Staff can determine if applicable)
(Yf aot prepAid,a sewer cunxection pecmit wW not bc issued) .
�Sewer Connecti /Dis�' nAect/ p�ir(S35.00/per Stub) $ � �� —
Pipe size inches;matenal Schd 40 air iested; cast iron
❑'R'ater Gonneetion/Disconnect/Ytepair(535.00/Per Stub) $
Pipe si2e inches;macerial Sehd 40 air tes�ed; casc iron
1. SIJBTOTAL of Peimit Requzstod; $- `� � ` �D
2, STAT'�SUItCT�ARG� $ .50
3. POSTAGE&HANDI-ING(On1Y on Mail-Tn Applications) $ 1.50
4. TOTAY,PEYZMTY`�'EE(Add Y-mes 1-3 Above) s��
r �� ,�, , . ��. ,�i.D��['.'�IQI�I�AI:TNF�6RiVIATION�WATER IviE1'�1�5�.���": . r>�
� WAT�Yt NI�TERS must be picLed up and Paid for at orono Ciry Hall,mese are oa a se�te�e_rmit•
• WA'�R ME'TE1tS must be set xnd sesled by Orono Water DepArtment (95Z) 249-4600, npon
completion oi mecer in4callation.
7he undersigned h�ereby applies to the Ciry of Orono for issuaace of a Utiliry Permit,agrees to do
all work in su�ict accordance with the ordinaaces of the City and the re�ulations of the State of
Minnesota,and certifies tt�at all statements made cm this appiieation are,true and correec.
Applicant:�(� � �`� _ Dace•IV� /"�i�� —