HomeMy WebLinkAbout1985-12-20 Permit, City Sewer Connect #8249GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473,7357
Owner 1
Contractor
City License No
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures__)
Water Meter (Size—)
Meter#
Remote #
CITY PERMIT NO. 8249
Date /?- '_'?y
Address %,-:;?C S So '&au. "' ec/.
Address
❑ NEW ❑ ADDITION
Fee 3
Fee S
Municipal Water Connexion Fee S
❑Copper ED
Municipal Sewer Connj� tion Fee S -
❑ PVC f[l'dst ❑ p, Gla
MWCC SAC Charge //�� Fee S
On Site Septic System
ACKNOWLEDGEMENT
Fee S
The undersigned hereby acknowledges recelpt of title limited
permit. including acceptance of all special Information.
terms, conditions or requirements written above. The
undersigned understands and &greet under penalty of law
that this permit to striedy limited in .cope to the work.
activity or improvement specified: that this permit does
not pant say authority to. do work or activill t requiring
separete permit approval: and that this permit does not
pant authority W violate any provision of any city
ordlnmes or State law, rote or regulation. All work shall be
done in strict compWnce with Y City ordletanea, building
codes and/or health department regulations, and Mas be
subject to Inspection, approval or nNetion by the City.
Whe over w ordered. the undersigned epees to comet
soy work found to be in violation of the conditions of
this permit.
ture of Ap •tlicant
State License No.
❑ REPAIR
iter Well
!chanical Equipment
wing /Lifting Buildings
nd Alteration (Excavation,
Grading, Filling, etc.)
re
rinkler System (Fire)
her:
'ter -the -fact Investigation
TOTAL
State Surcharge:
Total Amount Paid to City
Fee
S
Fee
Fee
S
Fee
S
Fee
S_
Fee
S
Fee
S
Fee
S
Fee
S
/-� 'i
Fee $
Fee $ C:30 SPI
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature f City Official
i
Code: White -File Copy Canary --Inspector's Copy Pink -Finance Copy Gold -Applicant's Receipt