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Home My WebLink About2013-00034 - sewer disconnection ' ` CITY OF ORONO * Z 0 1 3 - 0 0 0 3 4 * 2750 KELLEY PARKWAY DATE ISSUED: OU15/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2789 PHEASANT RD PIN : 21-117-23-32-0005 LEGAL DESC : REG. LAND SURVEY NO. 0310 : LOT 000 BLOCK 000 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: WAT[;R&SEWER DISCONNGCT APPLICANT $EWER CONNECT/DISCONNECT/REPAIR 50.00 D.S.M. EXCAVATING WATER CONNECT/DISCONNECT/REPAIR 50.00 2916 ENTERPRISE AVE HASTINGS, MN 55033- STATE SURCHARGE SEWER& WATER 5.00 (651)480-1355 TOTAL 105.00 PAID WITH CC# 9252 OWNER TEYNOR, GAIL&JOSEPH 13225 CARDINAL CREEK RD EDEN PRAIRIE, MN 55346- AGREEMENT AND SWORN STATEMENT I'he work for which this permit is issued shall be performed according to the approved plans and specilications,applicable Ciry approvals,and the State Building Code. This permit is lor only the work described and does not grant permission for additional or related work which rcquires separate permits. All provisions of laws and ordinances governing this type of wark 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 atter work has commenced. The applicant is responsible for assuring all required inspections are requested in eonformance with the State Building Code.This permit may be revoked at an tin for e c use. �� ' �5 ' �3 �' ��l��t ��z � � �-;� �; Applicant Permitee Signature Date Issued, �Signaturc Datc SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. , � ' � �__-�... �c��cTTx us�or��,� � a 3 � ,�/�t�rO� City of Orono Date I2eceivea:��/�;�� Pertnit#�Qf�y` P.O.Box 66 2750 Kelley Pazkway ❑In-House SAC i7�temaination F�rm Cpt�ipl�ted �y �r Crystal Bay,MN 55323 �Q�,�� `�� (952)249-4600 ApprQved�}�(I3'Rea�air�d): ��r`s n��"j" 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 subiect to further review and mav not be issued when the aoplication is received) GrEAtEIZt4L QI�MATIC�N ' 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 befare it is covered. Call(952)249-4600,24+hour notice required. ; ' TYPE OF'PERMIT ' (Check All That A i ) ; �esidential(May Require Approval) ❑ Commercial(Approval Required) ❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs �isconnect ❑ Water Availability Connection For Future Hook-Up to Water Tob Site I Own�t'Inforn��tion: ' Site Address: a�� ''�`� 1`�C/ Owner: 5 �-�T/►r`� Mailing Address: City: Zip: Home Phone: Alternate Phone: Contraetar Inf`�mation: Contractor: +U-5. �'1 � �t,- Contact Person: V�I`k e /�.�v�.-f— Address: 2-`l I(o �i�t.ta-/A+�P State License#: � 4 3 ov 30 City: � Zip: SU� Expiration Date: Phone: !o �!- �l�0�'13 SS Alternate Phone: � �1-91�-�!3 y d r � � . �� .�" a'^ �: ��°.�,: � ❑ SAC Charge(2013 Rate=$2,435.00) $ (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 Connecti Discon pair($SO.00Rer Stub) � �G � Pipe size mches;material Schd 40 air tested; cast iron ❑ Water Connecti 'sconn pair($50.00/Per Stub) $ �8 ' � Pipe size inches;material Schd 40 air tested; copper ❑ Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Explanation: 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) Issue 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) $ l�S v v '' ADDITTQNAL INFORMATION-WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a s�arate permit. ■ 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 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. �� —/s -� Applicant: Date: � ❑SAC Charge(2013 Rate=$2,435.00) $ (SAC Chazge must accompany all sewer permit applications unless prepaid) (Orono City Staff can determine if applicable) (If oot prepaid,a sewer connection permit will not be issued) ` ❑Sewer Connecti Disco pair($50.00/Per Stub) $ J�� J Pipe size utches;material Schd 40 air tested; cast iron ❑Water Connecti ' con pair($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 Ezolanation: Contractor installed line to inside of house for future hook-up. Tlris line will be inspected by the Public Works Department. Reauired Before Water Connection Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Addirional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ ��U. �"U 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMTT FEE(Add Lines 1-3 Above) $ l d�J. v v � ONAL Il�tFOit�4ATIC)�+T—Y��TER A�EETEIt3 ■ 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 ineter 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 aze,true and correct. Applicant: /� '" � � Date: �'I S—�