HomeMy WebLinkAbout1986-06-17 Permit, Sewer Connect #8529GENERAL PERMIT
CITY OF ORONO
Owner
Con tray
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
City License No.- 1 CJS
REMARKS AND SPECIAL CONDITIONS
CITY PERMIT NO. 8529
Date
� .r
Address 621 I � A,
- 41"s
Address <,2yLLza2
State License No.
PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing (#fixtures )
Water Meter (Size )
Meter #
Remote
Fee S (Water Well
Fee S -- _
Municipal Water Connection Fee S
❑Copper n
Municipal Sewer Connection Fee S
❑ PVC 4Cast rl
MWCC SAC Charge Fee $
On Site Septic System
ACKNOWLEDGEMENT
Fee S
The undersigned hereby acknowledges receipt of this limited
permit, including ac-eptance of all special information.
termc conditions or requirements written above. The
undersigned undentands and agrees under penalty of law
that this pewMt is strictly Whited in scope to the work.
activity or improvement spreified: that this permit does
not grant any authority to do work or activities reauidug
separate permit approvals- and that this permit does not
Want authority to violate any provision of any City
ordinance or State law. rule or regulation. All work @ball be
done in strict compliance with all City ordinances. building
codes and/or health department regulations. and shell be
subject to inspection, approval or resection by the City.
Whenever to ordered. the undersigned agrees to correct
any work found to be in violation of the conditions of
dos permit.
Signature o pplicant
echanical Equipment
Moving /Lifting Buildings
Sq,—j ;--
Laney Alteration (Excavation.
Grading. Filling, etc.)
Fire
Sprinkler System (Fire)
Fee $
Fee $
Fee S
Fee $
Fee S
Fee S
Other: Fee S
After -the -fact Investigation Fee S
TOTAL
State Surcharge:
Fee S
Total Amount Paid to City Fee S 30 - S
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signa*ure of City
Code: White - File Copy Canary -- Inspector's Copy Pink -Finance Copy Cold-Applkant's Receipt