HomeMy WebLinkAbout2006-P09782 - sewer connect PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P09782
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
4/24/2006
SITE ADDRESS: 1200 Old Crystal Bay Rd S Unit#
Wayzata,MN 55391
PID: 09-117-23-13-0007
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: Thompson Plumbing OWNER: Dean&Kelly Leischow
15001 Minnetonka Ind. Rd. 2245 Platwood Rd
Minnetonka,MN 55345 Minnetonka,MN 55305
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.
APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
FOR C41TY USS OhH,I
(...-07,„,, City of Orono !bate Rgcetved, r',Pernut
P.O.Box 66
it 0 2750 Kelley Parkway i,[]'Iii HOuse SAO:Det°erminatton Form Co Meted
�"'� . Crystal Bay,MN 55323
�, ,t .yo (952)249 4600 .,Approed By(IfRequlre�l):; 36
CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
(ALL PERMITS- May be subject to further review and may not be issued when the application is received)
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 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 State Code requirements.
8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required.
I
7 'F, I i k cV �': F E
{ TYPE OF P:ER�+ITT � � {� �� {•
,(Cheek All' that ilpply) ':
Residential(May Require Approval) E Commercial(Approval Required)
E New Connection ❑ Additional Connection ❑ Re-Connection ❑Repairs ❑ Disconnect
Job Site=/ Owner Information:
Site Address: /o? 00 (DU_ C .-\- Uo-
__
Owner: ( \Sc\cx,3 _ Mailing Address:
City: ,c-orco Zip: ' S3q\
Home Phone: Alternate Phone:
Contractor Information:
Contracto -0\0 rp Contact Person: 1 GL.r\U 4
Address: I 6 rtl .p. I.r4v&-\ -‘,U2 State License #: c\;3r11 P
City: \'1' bc' C _ Zip:SB9SExpiration Date: I a-3\-p L
Phone:c1,9-c3' Alternate Phone:
X '',1 ,I J A,.
ic
i 1 1 II ) IJ �� 1l p 'il i `fi t 1 1 1 .,
❑ SAC Charge(2005 Rate=$1,450.00) $
(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)
‘aSeweConnect o/Hts'Cunrreetir($35.00/Per Stub) $
Pipe size Li a inches;materialPJ(`.Schd 40 air tested; cast iron
N`l'-' C tin/ it($35.00/Per Stub) $
- ;ma eria - . '! • - ted; copper
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ ks
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
ADDITIONAL;INFORMATION'—WATER METERS.
• WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit.
• WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of meter installation.
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,true and correct.
Applicat f"..00./74,0\ Date: 4- o\i
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