HomeMy WebLinkAbout1986-06-12 Permit, Sewer Connect #8520GENERAL PERMIT CITY PERMIT NO. 85520'
CITY OF ORONO
P.O.BOX 6!, Date
CR) S IAL BAY. MINNLSU [A 55323
(b 1 _) 473-7357
Owner It nQ�l I L40-('- ' Address LcilY 8r �a t, . .
Contractor-,�"}f rr4 r II(1Y1l=� n� Address%G%/ 1�t, .n� !Yi /$tr j
0 �-
City License No. ��� _ State License No.
REMARKS AND SPECIAL CONDITIONS
.� AC DA i Diet ifs /4 -
PERMIT TYPE AND FF I 0 NFW ❑ ADDITION ❑ REPAIR
I Inside Plumbing lMtixturr+_! Fee S
Water Meter iSize—)
Meter 9
Remote i)
Fee S. _
Municipal Water Connection Fee
❑Copper ❑
Municipal Sewer Connection Fee $v
Af PVC ❑ Cast 0_
MWCC SAC Charge Fee S _
oil Site Septic System
ACKNOW I -))UNI ENT
Fie 5
The u;iderngned hereby selinortedaes receipt of this limited
precut(. ins apee
including acceptance rel all Information.
temp, conditions nr retlulnments rntten slims, The
undersigned undentands and stars under penalty of law
Matthfa permit is strictly limited In scope to the work.
acus Ity ew lmptusemrnt speciMd: that Nu prrrnst don
not grant any, authority to do work or actisitin nqulring
separate pertnll approvals: and that this penult does not
grant Wthorlty to atolate my prosldon of any Ott,
ordinance State ale lar. rule or regulation. All work shall be
done In strict complisnn with as City ordinances. building
codes audlor health department regulations. and shall lir
subivetto Inspection. approsal nr relertinn by the Lily.
Whenrs q so ncd,ml. the undersigned agrees to comet
any work Iwrnd to be in stolauon til the conditions of
this permit.
Sign of Applican!
Fee S
Equipment Fee S
Moving /Lifting Buildings
Land Alteration (Excavation.
Grading. Filling. etc.)
Fire
Sprinkler System (Fire)
Other:
After -the -fart Investigation
TOTAL
Fee S�
Fee S
Fee
S
Fee
S
Fee
S
Fee
S
State Surcharge: Fee S -SO
Total Amount Paid to City Fee o
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
t►r . T1s. i c l c
Cudc White -I de copy Canary Inspector't t'opy Pink I inanm Copy Gold -Applicant's ReMpt