HomeMy WebLinkAbout1984-01-26 Permit, Land Alteration #7307CITY PERMIT
GENERAL PERMIT
CITY OF ORONO Date_
f .O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(61'-))473-7357
Owner Address
Contractor Address
City License No,
REMARKS AND SPECIAL CONDIT IONS
PERMIT TYPE AND FEE: ❑ NEW 0 ADDITION
Inside Pluml.ing ( # fixtures ) Fee S
Water Meter (Sire
Meter k _
Remote N .
Fee S
Municipal Water Connection F _
[hopper a -
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast n
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee S
The undersigned hereby acknowledges receipt of this limited
permit, utcluding acceptance of all special information,
terms, conditions or requirements written abose. The
undersigned understands and agrees under penalty of law
that this permit Is strictly limited in scope to the work.
actitity or improsement specified. that th, permit does
not Quit any authority to do work or acU+iues requiring
separatepermit approvLls: and that this permit does not
grant a-Ithority to vtulate .ny provlslon of anv Citv
ordinance or State law, rule or regulation. AU work .+nal] be
dune in strict compliance with all City ordinances, building
codes andlor health department regulations, and shall be
subjectto inspection, approval or relecdon by the Cils.
Whenever to ordered. the undersigned agrees to curer,
any work found to be in %solation of the conditions of
this permit.
Signature
State License No.
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Ltion (Excavation,
Gradin • Filling, etc.)
Other:
After -the -fact Investigation
TOTAL
Fee S
Fee S
Fee S
Fee S
Fee S OP
Fee S
Fee S
State Surcharge: Fee S So
Total Amount Paid to City Fee S SSo. 0
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Si t • of City Ofti ' l
J
Canal)' Inspector'% Copy Pink finance Copy Gold- Applicant's Receipt