HomeMy WebLinkAbout1985-12-06 Permit, Sewer Connect #8227CGENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
CITY PERMIT NO. 8227 -
Date—
227 -
Date ��- 10.S
(612)473-7357 /So. /S C'
"; /`3
Owner R I (.,j� L�� t�1 tri 1 ll-_ J�11 Address �.
Contractor Address
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION
Inside Plumbing (#fix.ures_) Fee S
Water Meter (Size—) Fee S
Meter#
Remote #
Municipal Water Connection Fee S —_—
[]Copper n
Municipal Sewer Con ection Fee S 40' _11c,
❑ PVC Cast r
MWCC SAC Charge Fee
On Site Septic System
ACKNOWLEDGEMENT
Fre S
The undersigned hereby acknomledps recelpt of this Welted
pelmlt. including a- true* of as we" information,
terms. conditions or requirements wdtten Wove. The
undershimed understands and agrees under Penalty of law
that title permlt In strictly limited in seope to *a wort,
activity or improvement specified; that this summit dras
not pant any authority to do wart or activities requiring
separete Permit approv&W and that this pemlt does not
pant authority to Notate spy provision of any City
ordinance or State taw, rule or regulation. AD work shall be
gape In clrict compliance with as City ordinaries, building
codes and/or l»alth dwaelment regulations, and WW be
subleet to lespsedon, approval or selection by the City.
wkwnavar an ordered. dw undersigned ag au to cornet
any work found to be in violation of the conditions of
this permlL
Signature of Applicant
State License No.
❑ REPAIR
iter Well
:chanical Equipment
wing /Lifting Buildings
nd Alteration (Excavation,
Grading. Fillin, tc.)
V
rinkler System (Fire)
Investigation
TOTAL
F:
�
Fee
S
Fee
S _
Fee
S
Fee S
Fee S
Fee S
Fee S
State Surcharge: Fee S SO
Total Amount Paid to City Fee S�
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signatu of City Of tcial
Code. White Far Copy Canary AngrectotY Copy Mak-Finance Copy Gbid-Appacagt's Reaslpt