HomeMy WebLinkAbout1986-04-01 Permit, Sewer Connect #8403GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 8403'
Dateg�l1 S6
Owner Pe—rig Address, /5 � TeL
Contractor r Address �5C.� 7 ' l Or a•
City License No. l Q State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing Oftxtures_)
❑ NEW ❑ ADDITION
Fee S
Water Meter (Size _) Fee S
Meter#
Remote #
!7 tf�l_, U
❑ REPAIR
ater Well
echanical Equipment
oving /Lifting Buildings
Fee S
Fee S
Fee $
Municipal Water Connection Fee S Land Alteration (Excavation, Fee S
❑Copper Q Grading, Filling, etc.)
Municipal Sewer Connection Fee S —
Fire Fee S
❑ PVC ❑ Cast Q
MWCC SAC Charge Fee S
On Site Septic System
ACKNOWLEDGEMENT
kler System (Fire)
r:
Fee S After -the -fact Investigation
Ttie undersigned kereby ackno+ladyn rec- t of"llsaited
permit, Including acceptance or all special lafornallon,
tertaa, conditions or requtnmenU .dtlaa above. 71s
undantlgned undars—do and apeee uadar Naalty of la.
that L W peranit la strictly llmllsd in KOM to 161e wart,
activity at tmprowmmt spacln*d; that " permit dons
not grant anyauthority to do work or aelmdas requiring
separate permit approvals: and that lW gemil does not
grant authority to violate any /rovidon o1 soy Clly
ordinance or Stale las, rule or regulation. All work 16x11 be
don* In strict compilaoce .Iib all City ordlaaam.6Wld+y
Codas and/or health departmeat regulations. area l6all a
subject Lo inspection, approval or rejection by t6a (:lty.
Whaaever m ordered. the underaipaed apeae ' too
any work found to be In •iolatlon of the con.tlticess of
this permit.
Signature Applicant
TOTAL
Fee S
Fee S
Fee S
State Surcharge: Fee S 1ST
Total Amount Paid to City Fee S 3G__56
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Off ' 1
Code: White - File Copy Canary–tntpector't Copy rink–Finance Copy Gold –Applkant'a Receipt