HomeMy WebLinkAbout12-23-1985 Permit, Sewer SAC Charge #8254jlNERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner yO-. __________________
CITY PERMIT NO. 8254
Date.
Contractor.
Address.
Address.
/.^9^ Afhn, ^y.
City License No..State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE:
Inside Plumbing (#fixtures —)
Water Meter (Size__)
Meter#_____________
□ NEW □ ADDITION □ REPAIR
Remote
Municipal Water Connection
Jopper
Municipal Sewer Connection
□ pVC DCast Q.
MWee SAC Charge
On Site Septic System
Fee S
Fim. s:
Water Well Fee
Mechanical Equipment Fee
Moving /Lifting Buildings Fee
Land Alteration (Excavation, Fee
Grading, Filling, etc.)
Fire. Feec
Sprinkler System (Fire) Fee
Other: Fee
After-the-fact Investigation FeeFee S
ACKNOWLEDGEMENT
The undersigned hereby kcknowledges receipt of this limited
permit, including ecccpUnce of eU 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 actlWties requiring
separate permit approvals; and that this permit does not
grant authority to violate any prodsion of any City
ordinance or SUtc law, rtUe 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 vIoUtlon of the conditions of
this permit.
Signature of Applicant
__AAa ^
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee
This pennit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
Code: Wliltc-Illc Copy Canar>'-lnspcc<:or*5 Copy Pink-Financc Copy Gold-Applicant's Receipt