HomeMy WebLinkAbout1985-11-20 Permit, Sewer Connect #8200GENERAL PERMIT CITY PERMIT NO. 8200
CITY OF ORONO 1-�
P.O.BOX (10 Date
CRYSTAL BAY. MINNESOTA 55323
(612)473-7357
Owner Address �a �� i7rinar Sfr
Contractor _ �-. Address
r
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS__ I
PERMIT TYPE AND FEE
Inside Plumbing (P. fixture._ )
Water Meter (Sin _1
Meler #
Remote i' -
❑ NFW ❑ ADDITION ❑ REPAIR
Fee S
Well
Fee S ____ ---- IMechinicil Equipment
Municipal
Municipal Water Connection Fee
�
❑Copper J
Municipal Sctver Connection Fee S
V(' ❑('ast
MWCC SAC Charge. Fee S
On Site Septic System
ACKNOWLEDGEMENT
Fcc
1he undrrsiosed hereby arknowleders mcelpl of this Urnited
permit. Includutg acceptance of as special Information,
Arms, Conditions or requirements written &b*. The
uruLrslor
aned understands and &pees under penalty of law
that this permit Is strictly Whited in scope to the work,
activity as improyemand
t speathis ed: that permit doe.
not grant any authority to do work or activities requiring
separate permit approvals: and that this Permit does not
pant authority to .tolste any provision of any city
ordinance as State law, rule or regulation. Aa work shwa be
dome In strict comelianee with as city ordinances, buddins
codes and/or health department regulations, and Was be
wrbleet to inspection. approval or rection by the city.
NTenewr w ordered, the undersigned agrees to correct
any work found to be in Nolation of the conditions of
this permit.
Signature of Applicant /
J d/
'.Moving /Lining Buildings
Land Alteration (Excavation.
Grading. Filling. etc.)
Fire
Fee
S
Fee
S
Fee
$
Fee
S
Fee
S
ler System (Fire) Fee S
Fee S
fter-the-fact Investigation Fee S
TOTAL
State Surcharge: Fee S s L
Total Amount Paid to City Fee S W.60
This pertnit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature f City Officio
Code. White -File Copy Callan- -Inspector's Copy Pink -I Pence Copy Gold -Applicant's Receipt