HomeMy WebLinkAbout05-19-1986 Permit, Sewer Connect #8472GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
CITY PERMIT NO.8472
Date.
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City License No-------------1^1
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Address.
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State License No..
REMARKS AND SPECIAL CONDITIONS
S' # S3S<^
PERMIT TYPE AND FEE: □ NEW □ ADDITION
Inside Plumbing (^fixtures ) Fee S------------
) Fee S------------Water Meter (Si?.e
Meter#___
Remote #.
Municipal Water Connection Fee S.
ropper
Municipal Sewer Connection
E^PVC DCast Q.
MWee SAC Charge
On Site Septic System
Fee S 36.cyD
□ REPAIR
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fire____________________
Fee S.
Fee S.
Sprinkler System (Fire)
Other:_____________
After-the-fact Investigation
Fee S.
Fee S.
Fee S.
Fee S.
Fee S.
Fee S.
Fee S
Fee S.
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of 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 viotaU any provision of any City
ordinance or State law, rule or regulation. All work shall be
dune 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 violation of the conditions of
this permit
Signature of ApplicantSignature of i
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S_L.
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This permit is not valid until the proper fee is paid and
It is approved by an authorized City Official.
Signature of City Official
Cctlc: Wiltc-MIc Copy Canaiy-lnspcctor’i Copy Pink-I'lnanec Copy Gold-Applicant's Receipt