HomeMy WebLinkAbout2008-P12030 - sewer connect PERMIT
, C!�Y OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p12030
Crystal Bay, Minnesota 55323 Permit Type:
Sewer and Water Permit
(952) 249-4600 Date Issued: 5/6/2008
SITE ADDRESS: 4205 North Shore Dr Unit#
Mound,MN 55364
PID: 07-117-23-43-0004
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:
SAC Pd 10/1/70, 2551
FEE SUMMARY: Pernut Fee: $ 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Highmark Builders Inc. OWNER: Mary Jo Peterson
12245 Nicollect Ave S 4205 North Shore Dr
Burnsville,MN 55337 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,!? .L�!
,APPLI' T PE MITEE SIGNATURE ISSUED BY SIGNATUKE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
'1
FOR�CITX IISE 01aTLY
,���, City of Orono Date Iteceived; Permit#
Q� O P.O.Box 66 , _
2750 Kelley Parkway ❑In-House SAC Detemiinatiori Fomi Completed .
� �.� Crystal Bay,MN 55323
� (952)249-4600 Approued By(If Required�:
CITY OF ORONO-SEWER& WATER/GENERAL PERNIIT
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
(ALL PERMI7'S- Mav be subiect to further review and mav not be issued w6en t6e aoolication is received)
GENERAI;INFOR1VIAfiION
1. You may apply for utility permits by mail or in person at the City o�ces.
2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will
be sent by return mail within 2 business days.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the permit card is available on the job site.
5. Utility connection permits 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 permit does not grant this approval.
7. All work must be done in accordance with Sta.te Code requirements.
8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required.
T�PE OF PE�N�.IT �
' ' (ChBck�11`Tfiat A . 1 s
�`Residential(May Require Approval) �Commercial(Approval Required)
�New Connection ❑Additional Connection �Re-Connection
�Repairs ❑Disconnect
Job'�ite/Ownar Info�nation: '.
Site Address: �%��J v � : S o�,P „
Owner: f�`i� lr.r.�-��,.l� �c�,�wO� Mailing Address:
City: �G•-:��, cc�. ��� Zip:
Home Phone: Alternate Phone: ��� -���-�d'7�
Contra�tor:Informatiari: '''
Contractor: � �C � l Contact Person: J�S o-�. �r,,.rd�1��
Address: �. S��a�D�"�r�P State License#: _�����o�-(��
City: ,���C o �''1�/ Zip: SdZo Expiration Date:
Phone: ���`����.5��� Alternate Phone: C��l P c �-�����
. . � . `�
. C�.��� � 1
� \
L/ �
,��"��5�'����'�������'�"�+"�, � �
�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)
�Sewer Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; 0 cast iron
❑Water Connection/Disconnect/Repair($35.00/Per Stub� $
Pipe size inches;material Schd 40 air tested; copper
1. SUBTOTAL of Permit Requested: $ ,
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMTT FEE(Add Lines 1-3 Above) $
ADDITIONAL INFQRMATION-'�VA'TE�Z IYIE`i'ERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a segarate nermit.
■ 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
a11 work in strict accordance with the ordinances of the City and the regularions of the State of
Minnesota,and certifies that all statements made on this application are,true and correct.
Applicant: � Date: ��� ��
°Reset Fvrm t =
� ,