HomeMy WebLinkAbout1985-12-26 Permit, SAC #8258GENERAL PERMIT CITY PERMIT NO. 8258
CITY OF ORONO Date
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner Address /,eA K2 - L;
Contractor Address
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
Water Meter (Size_)
Meter#
Remote #
❑ NEW ❑ ADDITION
Fee S
Fee S
State License No.
❑ REPAIR
ater Well
echanical Equipment
oving /Lifting Buildings
Fee S
Fee S
Fee S
Municipal Water Connection
Fee S
Land Alteration (Excavation,
Fee S
rJ
Grading, Filling, etc.)
[:]Copper
Municipal Sewer Connection
Fee S
Fire
Fee :+
❑ PVC ❑Cast 0
n
Sprinkler System (Fire)
Fee t
MWCC SAC Charge
Fee S
Other:
Fee $
Un Site Septic SyflPm
Fee S
After -the -fact Investigation
Fee S
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of IN mal information.
terms, conditions or requirements a:Itten above. The
undereianed understands and agre" under penally of law
that this permit is strictly limited in elope to the waft,
activity or improvement speclned: that tyle permlt does
not grant any authority to do wort or activities requiring
separste permit worovale: and that " permit does not
{rent authority to violate any provision of coy qty
ordlnueo or State law. Me or regulation. All work shall be
dose in rtfet eosnptianee with as Lily ordivunae, building
codes andlor b@d* dgartsent regulations, and rtao be
subject to ha+aetlmn, approval of rejection M re qty.
Whenever so ordered. We undersigned agrees to correct
any work found to be N vioLgoa of the Conditions of
thu Permit.
Signa ure of Applicant
Z_W_&Z_
a
Code: White-FIk Copy Canary-tr%Vmtor't Copy
TOTAL
State Surcharge: Fee S
Total Amount Paid to City Fee S 4?51_0
110
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
SI®tat Of Clty Of cial
Pink -Finance Copy L Gold-Appllcant•r Receipt