HomeMy WebLinkAbout2007-P11576 - sewer/water permit v 1
PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p11576
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued:
l0/15/2007
SITE ADDRESS: 3768 North Shore Drive Unit#
Wayzata,MN 55391
PID: 08-117-23-34-0063
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer&Water Disconnecri�
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 70.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Bohnsack&Hennen Excavating OWNER: Nancy Blair
17072 Revere Way 5501 Village Dr
Prior Lake,MN 55372 Edina,MN 55439
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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APPLICAN P T NATURE IS UED BY SIGNATURE
Copies: 1-File(SignaturesReguired), 1-Applicant, 1-MonthlyReports, 1-Assessing,(IfSeptic, 1-Septic) Page 1
�SAC Charge(2007 Rate=$1,675.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
3s=
[�Sewer Connection isconnect Repair($35.00/Per Stub) $
Pipe size��_inc ; nal P�� Schd 40 air tested; � cast iron
3 5"=
[�'Water Con ��tion/ isconne Repair($35.00/Per Stub $
Pipe size � inche , erial 1"K Schd 40 air tested; � copper
coPP.,.
1. SUBTOTAL of Permit Requested: $ 7U �
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �t� . O v
AUD�'T'IO1�tAL I�tFOR�IA"T`�t�l�l�-'4��. �11�ETE�S
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a s�arate permit.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
comptetion 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 that all statements made on this application are,true and correct.
Applicant: Date: �a�-0�
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