HomeMy WebLinkAbout04-24-1986 Permit, New Sewer Connect #8432GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
CITY PERMIT NO. 8432
Date
Owner,PAC.iSer\-^
Contractor.
City License No---------V ___________
Address.
Address,
/jQ< AeFd!^
State License No.,
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_
NEW □ ADDITION □ REPAIR
Water Meter (Size—)
Meter#_______
Remote #.
Municipal Water Connection
,opper
Municipal Sewer Connection
l^PVC □ Cast Q.
M>VCC SAC Charge
On Site Septic System
Fee S.
Fee S.
Fee S.
Fee S 30 :
■kK.rJ. s
Fee S.
Fee S.
Ot
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fire____________________
Sprinkler System (Fire)
Other:_____________
After-the-fact Investigation
Fee S.
Fee S.
Fee S.
Fee S.
Fee $.
Fee S.
Fee S.
Fee S.
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt ol this limited
permit* including acceptance of all special information,
terms, conditions or requirements written above. The
undersigned understands and agrees under penalty of law
that this permit is strictly limited in scope to the work,
activity or improvement specified: that this permit does
not grant any authority to do work or activities requiring
separate permit approvals; and that this permit does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subject to inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in \'iolation of the conditions of
this permit.
Signature of Applicant
TOTAL
State Surcharge:
Total Amount Paid to City
Fee So
Fee S.
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
Code: \Wiitc-I-ilc Copy Canary-Inspector’s Copy Pink-Finance Copy Gold-Applicant’s Receipt