HomeMy WebLinkAbout2006-P10633 - sewer connection - PERMIT
C'rTY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P10633
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
12/14/2006
SITE ADDRESS: 4017 North Shore Dr Unit#
Mound,MN 55364
PID: 07-117-23-44-0005
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer Connection
DETAILS:
Approved per resolution#: '
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 35.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: T&J Concrete OWNER: Fred Johnson
17720 Highway 65 4017 North Shore Dr.
Ham Lake,MN 55304 Mound,MN 55364
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.
i
1.. / 61/44-
a1'/
YYrI
AP LICANT PE E SIGNATURE j D BY SIGNATURE ,
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 4
12/14!2006 16:42 3131 T J CONCRETE
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ITY
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OffORONO—SEWER&WATER
iGENERAL ERMIT
( rte:so anmy require"went by xbe 84dieg Ofuiaend/orPubliC Wade De
1• You may apply for aril' •, . ,• ' •.. .. , . • •.,,;� ,., ' ,
2. Mailed in permits by mail or in ers
be amt b apPucatioas are subject to the postageP on at the City offices.
3• et y return mail wi i 2 business dayand handling fee shown below. Permit cards will
wits are not valid poll you receive a permit Card.
4• Work must lot begin ug1C93 tate
peunit 5. Utility connectionpits may becard i licensed
co on the job site.
6. Contact the Pubic Works DepartmentYed to heed�w'$Gtors
DO NOT " ublic or YN y g (952-249-4600 for utility stub as-built locations.
approval of the Public works Department.TT`ND DO NOT TAP ANY MAIN
7. All work must be dole c accordance Issuance of a *without p eapreas
royal,
7. All work roust be with State Code requirements.does lot grant approval,
inspected before it is covered, Call(952)249..4.600
., ,24+hoyr notice required.
' 1.'' ��•. h. I' TYPE '�l•..Y
:;,• ,,1'I. • (sok'Ali • k '1 I":::.i..,' I '.
Residential(May Require APptOval) 0 Commercial(Approval Required)
4 )
;Eq New Connection, 0 Additional Connection
Re-connection ❑Repasts ❑Disctumect •
PckSite/.. eti n binialioa; , • . ,
Site Address: _0 Li , i by t'�• S1'IAYY, b nV��
Owner: Mailing Address:
Cary; _ Zip:
Home Phone: Alternate Phare;
•I
.55
contractor:
J (,bl'sGYtf- Contact Person: vat �rrv�
A 7,0 4A,1�13 w J State license#:
fy. rn Z:p Expaatioa Date:
Phone, '4 Alternate Phone: (OkZ �5 2 a ul
12/14/2006 16:42 7634131 027 T J CONCRETE PAGE 02102
+9822494616
T-104 P.002/002 P-800
• 4tt�� �7y�;f, �{
.IJIJ;4111'�3.—SR- �a !�
0 SAC C6 (2005 Rate�81,450.00)(SAC Charge $
� all sewer
ue permit
applications unless Cry Staff eau accompany
applicable)not prepaid,'a sewer c a�permit pe d
will not be Issued),
Sewer Connection/Disconnect/Repair(S35.00/per Stub)
Pipe size 4�!inches;materialSchd 40 air tested; cast iron
fC j ater Connection/Disconnect/Repair035.00/Per Stub)
• y Pipe size inches;materialSchd 40 air tested; cast iron -�—�
1, SUBTOTAL of Permit Requested:
S � J
2. STAT SURCHARGE
S
3. POSTAGE&HANDLING(Only on Mail-In Applications)
d. TOTAL PERMIT FEE(Add Lines 1-3 Above) SO
,- cV
• WATER METERS must be picked up and paid for at Orono City Hall,
• WATER METERS must be set addsealed by Orono Water D p these t ( 5 a
completion of meter installation, eP en (952) 24g g600� n
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
Minnesota,end certifies that all stat7rits made on this a.,. - and the rtrulationc of the State of
.,. are,tine and coned.
Applicant; 'L 1 lR /�• /► rate: l J4 IV�,
f