HomeMy WebLinkAbout1985-11-04 Permit, SAC #8165GENERAL PERMIT
CITY OF ORONO
P O BOX 66
CRYSTAL BAY. MINNtSOTA 553:3
(6i:)473-7357
CITY PTRMIT NO.8165
Date.
Owner,f)ohn\
C.mlni. lnr U'f J ) , Sj-'t > AJ.Iry« . HO / L -/ -f t V
City Utensc No. Pl'J YI M I "V_______________ State License No_____________j I/tL
RLMARKS AND SPtCIAL CONDITIONS
nrec/.i ;
PERMITTYPli ANDH F:□ NLW □ ADDITION □ r 1 PAIR
Invide Plumbing (ftiMua's ___1 fee S Water Well fee S
Water Meter (Si/e___1 fee Mechanical Equipment Fee $
Meier#
Remtite S Moving Lifting Buildings Fee $
Municipal Water Connection
ricopper n
fee K land Alteration (fxc*avation.1 ee S
Cirading, Filling, etc.)
Municipal Sewer Ciiiineclioii
□ pvc □(.let n
fee s. 30JP f ire _Fee S
Sprinkler .Sysiein iFirel Fee S
MWee SAC Oiante fee $.............-Other____Tee S
On Site Septic Sy stem fee S After-the-fact Investigation Fa*.* ^
ACKNOWLIDC.I Ml NT TOTAL
Tfi* uRdrmgnvd b»t*bir •HmowIrdaN ivcflpt of thl« ttmlUd
pvrmit. toctu41ns acccpUoc* oi all ipMial tafonaatto*.
Irtma, t^rnmUarnm at r»«iitf»inanto «nt«an abm*. Hir
undanicnod undarstan^ a«d afraaa «mdar panaliv of la«a
that ihia brnnlt u aUtctla hmilad la atopa to iha «oah.
artivtla m hnproirainont «»aclflad; Ihal ihia pafvnli doaa
nrd vaat aay authoillir to do wotli tar aetlYlUas raquirtag
•aparala patoilt appratala. aad Mtat liMa panait doaa ael
srant aulhoiitv to atolata any paoatpon of aay City
ortUnaoca or SUta law. rula or ragulation. AB woall dtal ba
doaa ia autrt roaipllaaea aidi aB City ordttiaaaaa. huildins
coda# and/or haalUi dapattmaal ragtiUttona. Mid ahall ha
aublaat to laapartloo. appratai at ralaatloa by fk* Ott.
dhaaayar to ordarad. Bm undardgaad Mraaa to rorracl
any worb found to ba In «iolaO»n of tha r«iadltion» of
Udapaimit'7
Signatiitr OI /^plicant j
rr(r.„V /!r
State Surcharge:
Total Amount Paid to City
Fee S.. i'O
f„ , 30..-g
This permit Is not valid until the proper fee is paid and
it is approved by an authori/ed City Olficial.
Signatim.* of City Official
Cotlr miUte lirCtify rafur> bt^lortCopK Pink Itnanc< Cofv Cnild ApfilKanrt Rriripl