HomeMy WebLinkAbout2008-00212 - sewer disconnect : ' ` CITY OF ORONO PERMIT NO.: 2oos-oo212
: 2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 09/10/2008
952 249-4600 FAX: 952 249-4616
ADDRESS : 4315 NORTH SHORE DR
PIN : 07-117-23-43-0028
LEGAL DESC : SAGA H1LL REVISED
: LOT 000 BLOCK 018
PERMTT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DISCONNECTION
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 35.00
AREA WIDE PLUMBING STATE SURCHARGE SEWER&WATER 0.50
9989 190TH ST. TOTAL 35.50
SILVER LAKE,MN 55381
(952)292-5297
Minnesota State License#:61937-PM
OWNER
NESBITT,SHARON
4315 NORTH SHORE DR
MOLJND,MN 55364
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. 1'his permit is for only the work described and does
not grant permission for additional or related work which requ'ues separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified 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 construction is
suspended for a period of 180 days at any time after work has commenced
1'he applicant is responsible for assuring all required inspections are
requested in conformance with the S uilding Code.'fhis permit may be
revoked at any ' e for d cause.
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Applicant ermitee Signature Date Is e By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE.
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❑SAC Charge(2007 Rate=$1,825.00) $
(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)
❑5ewer Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches;maxerial Schd 40 air tested; cast iron
❑Water Connection/Disconnect/Repair ($35.00/Per Stubj $
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 PERMIT FEE(Add Lines 1-3 Above) $
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■ R'ATER METERS must be picked up and paid for at Orono City Hall,these are on a sepazate nermit.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of ineter installation.
T'he undersigned hereby applies to the City of Orono for issuance of a Utility Pemut, 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, 11 s�atements made on this application are,true and correct.
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O,¢p�O City of Orono ��eiR�iv�d• �t� ,
P.O.Box 66 � � - � '�
2750 Kelley Parkway 0�i�se S1�L1e��naUdn�or�n�am�al�ted :
���� CrysCal Bay,MN 55323 � ' � �
(952)249-4600 1�iFivcc�B'�.(Tf'R�pft'� � ' ..
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CITY OF ORONO-SEWER&WATER/GENERAL PERMIT
(*Note:Some permits may require approval by the Building Officia]and/or Public Works Depaztrnent*)
• (ALL PERMITS- Mav be subiect to furt6er review and mav not be issued when the aoolication is receivedl
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1. You may apply for utility pernuts by mail or in person at the City offices.
2. Mailed in applications aze 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. Conta.ct 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 ezpress
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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(�.Residential(May Require Approval) ❑ Gommercial(Approval Required)
❑New Connection ❑Additional Connection ❑Re-Connection ❑Repairs �]Disconnect
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Site Address: Y 3/.� �0 2Th�s'No�� I�R t�e
Owner: ��uu�orv O�so�U Mailing Address: e(�/5 /�10�� S�o��e �IZ.
city: �2 DA�r`� zip: �s 3�6
I�e�ue Phone: qs 2- �2/- z� g� Alternate Phone:
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Contractor: ��-�a IA1��e Y'l��n��aJo Conta.ct Person: � P"��� "1 ���t�P v� �`�c
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Address: ��� �9� 'f � State License#: � � r� �� � ��
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City: S��v�-r L•�� Zip: -�S3� Expiration Date: °"
Phone: (5�� �`�? " �a S� Alternate Phone: (9�� a�� - S � 5 -1