HomeMy WebLinkAbout2001-P03574 - sewer disconnect �. PERMIT
��TY O F O RO N O Permit Number:
2750 Kelley Parkway- PO Box 66 P03574
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249�600 Date Issued: 3/2/2001
SITE ADDRESS: 4445 North Shore Dr
MOUND,MN 55364
P I D: 07-117-23-31-0001
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer Disconnect
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: �STONKA SEWER&WATER OWNER: GAYLE ERNEST BVITTIG
6501 COLJNTY RD 15 4445 NORTH SHORE DR
MOUND,MN 55364 MOLJND MN 55364
THE LJNDERSIGNID HEREBY REQUFSTS PERNIISSION TO MAKE TI�REAI.IMPROVIMENTS SPECIFIED
AND AGREES TO DO ALL V4�ORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND
STATE OF MINNESOTA BUII.,DING CODE REQUIREMENTS.
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TEE T I D BY SIGNAT'URE
Copies:City,Applicant,Assessor,Finance Page 1
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� CITY OF ORONO APPLICATION FOR UTILITY PERMITS `l ��
Box 66 (2750 Kelley Parkway) SEWER/WATER
Crystal Bay, MN 55323
GENERAL INFORMATION
1. You may apply for utility permits by mail or 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 the same day the application is received.
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 State Code requirements.
8. All work must be inspected before it is covered. Call(952)249-4600.
24 hour notice required.
JOB SITE ADDRESS: �7��� I�,�►��"� ���C'�' �a�
Occupancy Type: �Residential Commercial
Owner's Name: �� �✓�' Phone Number:
Mailing Address:_ 5�,��e ,g S s ����-' City: 7�•
Contractor's Name: „��S�h-��G�'�. ���c Phone Number: r S� •zl?�-��.5`�
MailingAddress: ��j( C�,�2��, (5 City: dl�le�.;vi 7�p• �S-�� i-/
PERMIT TYPE �v S(,o'�"�c��
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Municipal Sewer nnection ($35.00 per stub) $
pipe size inches; material Schedule 40 air tested; cast iron
SAC Charge (2000 rate $1,150.00) must accompany all sewer pernut applications unless prepaid.
If not prepaid, a sewer connection permit will not be issued.
Municipal Water Connection ($35.00 per stub) $
pipe size inches; material copper; other
WATER METERS must be picked up and paid for at City Hall.
Water meters must be set and sealed by Orono Water Department (952-249-4600) upon
completion of ineter installation.
REQUIRED minimum setbacks from drain field and septic tanks=75'
REQUIRED setback from sewer line=20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50
The State Building Code Division Surcharge of$.50 per permit must be
included for each well,sewer and water connection permit requested.
3. Posta�e& Handling (Only mail-in applications) $ 1.50
4. TOTAL PERMIT FEE(add lines 1-3 above) $
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 complete,true and correct.
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Signature of Applicant: C--� Date: �~ �- �
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION N IC C� SCHEDUIED '-�- v ��
PERMIT NO. ��`5 7/ COMPLETED " '� L- J`�
ADDRESS y��� /!/ � �1��-i�-/"� •
OWNER CONTR. �--�'�2�t.'nQ-.t. S �--Z(,/
TELEPHONE NO.
� DESCRIPTION S E' �-� P� Di S c a�N�L�'�-
lt� Ot FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i 09 PLUMBING RI 23 SEPTIC FINA� 35 HARD COVER REMOVAL
J 10 PLUM8ING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� �ORK SATISFACTORY:PROCEED �ROJECT COMPLETE
W CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ppHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hours in advance. (952) 249-46��
OwnerlCont,r tor on site:
Inspector ti G �
White Copylinspector's Ffle Canary CopylSite NoUce