HomeMy WebLinkAbout03-20-1986 Permit, Sewer Connect #8394GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner ^ _____________
Contractor S _____
City License No ^ ^
CITY PERMIT NO. 839t
Address / ^ ^^/)or .
Address j j^ ~K- )/(L^
REMARKS AND SPECIAL CONDITIONS
I " in ____>j- / '^foO I n
State License No.
PERMIT TYPE AND FEE:
Inside Plumbing (#fixtiiresi^)
Water Meter (Size__)
Meter#_____________
^ NEW □ ADDITION □ REPAIR
Fee S >^0
Fee S--------------
Remote #.
Municipal Water Connection
Q Copper Q____
Fee S.
Municipal Sewer Connection
5?PVC DCast Q.
MWee SAC Charge
On Site Septic System
Fee S
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S
Fee S.
Fire.
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 undeniKned hereby acknowledces receipt of this limited
permit* includins acceptance of all special Information,
terms, conditions or requlrcmenU written above. The
underslsned 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 \iolate any prodsion 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 relectlon by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be In violation of the conditions of
this permit.
Signatup^f Appli^nt
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S..CD
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: Wliltc-Hlc Copy Cinuy-lnspTctor’s Copy Wnk-Flnancc Copy Gold-Applicant's Receipt