HomeMy WebLinkAbout03-19-1986 Permit, Sewer SAC #8393GENERAL PERMIT
CITY OF ORONO
CITY PERMIT NO. 8393
5-Date.
Owner.
Contractor____
City License No..
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
On r~\ V. I ~\\ 6* ^ Address
_________________ Address_____________________________________
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
□copper □____
Municipal Sewer Connection
□ PVC GCast Q.
MWee SAC Charge
On Site Septic System
Fee S Water Well Fee
Mechanical Equipment Fee
Moving /Lifting Buildings Fee
Land Alteration (Excavation, Fee
Grading, Filling, etc.)
Fire Fee
Ff.i* s;
Fee S
'fc=s M'lS
Sprinkler System (Fire) Fee
Other: Fee
After-the-fact Investigation FeeFee S
ACKNOWLEDGEMENT
The undenlBned hereby ecknowledses receipt of thii limited
permit, tncludlnt acceptence of all ipecial Infomiatlon,
teimi, conditions or reQ^ilrements written above. The
undersigned understands and ^'creei under penalty of law
that this permit Is strictly UmiUu Zz *^ope to the work,
activity or improvement specified; that iMs permit does
not grant any authority to do work or activl*<#s requirini
separate permit approvals: and that this permit aoes 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 violation of the conditions of
this permit.
Signature of Applicant -—
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S,
Fee S.
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Offlcial.
Signature of City Official
Code: Whhe-File Copy Canaiy-Iiwpectot’sCopy Hnk-Ftaance Copy Gold-AppUcant’i Receipt