HomeMy WebLinkAbout2003-P06018 - sewer disconnect ITY F � PERMIT
C O ORO O
27FA K�Ifey Parkway- PO Box 66 Permit Number: Po6ois
Crystal Bay, Minnesota 55323 Pet-mit Type: Sewer and water Pernut
(952) 249-4600 Date Issued: 2i6�2oo3
SITE ADDRESS: 2800 Pheasant Rd
Excelsior,MN55331
P I D: 21-117-23-32-0004
DESCRI PTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Pernut Permit Sub-type(s): Sewer Disconnect
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 35.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL F'EE: $ 35.50
APPLICANT' RC Grading&Excavating,Inc. QWNER: James&James Echtenkamp
� P.O.Box 24 120 Birch Bluff Rd
Albertville,MN 55301 Tonka Bay,MN 55331
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.
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APPLIC T PERMITEE SIGNATURE I SUED BY SIGNATURE � �
Conies: 1-File(SiQnitures Required), 1-Avnlicant, 1-Monthlv Renorts, 1-AssessinQ, 1-Finance Page 1
(IJpdated 5/3/02)
CITY OF ORONO APPLICATION FOR UTILITY PERMITS
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay, MN 55323
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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 applicarion is received.
3. Permits are not valid until you receive a permit card. �
4. Work must not begin unless the pemut card is available on the job site.
5. Utility connection pernuts may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600)for urility 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 pernut 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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JOB SITE ADDRESS• �� � � ��� � � '�� ��� ��� � � �- ���,
Occupancy Type:_ _��Residential Commercial
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Owner s Name: � ����c� F �i E c 1�- �C-Y��-���� u.� �-� � �. Phone Number:
Mailing Address: City: I -���� Y r,�;�, I-�-- Zip:
Contractor's Name: �� C. r�t d .` ,: ` - cati�,��;-��� !�;� Phone Number: -1L�� 5 �l`�i i 1`��� �{
Mailing Address:� �� 1-�C�� ,t 7-��� City:f� 1� �{" "�r � Zip: ����C 1
PERMIT TYPE ❑ Connections ❑Repairs �Disconnect (Check One)
SAC Charge (2002 rate $1,200.00) , (Set Rate
)
Sac Charge must accompany all sewer permit applications unless prep ' .
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Connection/Disconnect/Repair ($35.00 per stub) $
pipe size inches; material Schd 40 air tested; cast iron
Municipal Water Connection/Disconnect/Repair ($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
l. Subtotal of above permit requested $
2. State Surchar�e $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per permit must be
included for each well,sewer and water connection permit requested.
3. Postaae &Handlin� (Only mail-in applications) $ 1.50 (Mail In Only)
4. TOTAL PERMIT FEE (add lines 1-3 above) $
The undersi�ed 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: L.% ��-v1.- � ' Date: �-` �<: " �'�?
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