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Home My WebLink About2013-00487 - sewer disconnection r ti CITY OF ORONO * z 0 1 3 - 0 0 4 B 7 * 2750 KELLEY PARKWAY DATE ISSUED: 06/12/2013 ORONO,MN 55356- (952)249-4600 FAX: (952)249-4616 ADDRESS : 4395 NORTH SHORE DR PIN : 07-117-23-43-0018 LEGAL DESC : SAGA HILL REVISED : LOT 000 BLOCK 018 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWER DISCONNECTON APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 BURNS EXCAVATING,INC. 3470 CO.RD 21 STATE SURCHARGE SEWER&WATER 5.00 MAYER,MN 55360- TOTAL 55.00 (612)685-4303 Minnesota State License#: 1888 OWNER CORNESS,JOHN&BARBARA 4395 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. This permit is for only the work described and does not grant permission for additional or related work which requires separate pemuts. Ail 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. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. 6 i /2� f� �i oZ�.,(� Applicant Permitee Signature Date Issu By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � ,. �-� � z3�� FOR Cl 1'US�ONL1' ' �-�� Clty Of Ol'On0 Date Received� '��Permit# �� 1 P.O.Box 66 ��= ,% . � � 2750 Kelley Parkwa}' ❑ In-House SAC Detennination Form Completed ��\� ' Crystal Bay,MN 55323 i (952)249-4600 Approved By(If Required): ��'�-Ls't�o�� ``.___-,. CITY OF ORONO - SEWER & WATER/ GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PERMITS- Mav be subieet to further review and mav not be issued when the apn��cation ic received) GENERAL INFORMATION 1. You may apply for utility permits by mail ar in person at the City offices. 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 wark must be done in accordance with State Code requirements. 8. All work must be inspected befare it is covered. Call (952)249-4600. 24+hour notiee required. TYPE OF'PERMIT �� (Checl� All That Apply) � �� ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) ❑ New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ,�Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/ Owner Information: � Site Address: ��J �C t ��f .S f�r= �rd;�-Z Owner: ��fr C'��t =J.I Mailing Address: � 7�-f L��al ��G`�- city: � ��« K - zip: �,;� .� Y.f Home Phone: Alternate Phone: �/L' S7�'�-�� Contractor Information: Contractor: !J<<{'iJ �'kr t�� - Contact Person: S1 r �--� �eci�-� Address: 3 y 7�' L��,� ,.,2.% State License #: j�� City: ��r Zip: rLr�• Expiration Date: Phone: �/Z�e�s '"YI�� Alternate Phone: `7�1 - %1f'-;J r�2 ! � ,: . >':a y �� :x ^�� 4 ''zi � ',1 �� 3- vs .2:.5 ^ „"" " .` .j � �. _�i.�. .x� - .��.. .,k,�. .V, F'�t�,� �k� ❑SAC Charge(2013 Rate=$2,435.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staff can dete ' e if applicable) (If not prepaid,a sewer connect� permit will not be issued) � �J Sewer Connecti /Disconnect epair($50.00/Per Stub) $ � " Pipe size inc ; al Schd 40 air tested, cast iron �Water Connection/Disconnect/Repair($50.00/Per Stub) $� Pipe size inches;material Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Exalanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Required Before Water Connection Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) lssue Water Connection Permit: 1. Collect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ �� 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �1 � � ,.: � ` �U�Q��`��:�'�� ;-�-�'�.T'�� :��+�" ,...�m� ` � ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate ermit. ■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon completioo of ineter installation. The undersigned hereby applies to the Cit�o�Orono for issuance of a Utility Permit, agrees to do all work:i� s�'`icY,accordanc� with't�ie•ordinances df.ttre City and the regulations of the Sta.te of Minnesota,and certifies that all statements made on this application are,true and correct. Applicant: Date: J�� / � �/�