HomeMy WebLinkAbout1986-06-12 Permit, Sewer Connect #8518GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 8518
Date
r"Y.,LG�'112�'yL' Address
Contractor �/
Cit' License No. � / State Lit
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE:
Inside Plumbing Ofixtures_)
Water Meter (Site_)
Meter #
Remote #
t4 NEW ❑ ADDITION
Fee S
❑ REPAIR
r Well
Fee S -- —._ (Mechanical Equipment
Municipal Water Connection Fee
[]Copper ❑
Municipal Sewer Connection Fee 5 _.30
4 PVC ❑Cast r_
MWCC SAC Charge Fee S _
On Site Septic System
ACKNOWLEDGEMENT
/Lifting Buildings
Land Alteration (Excavation
Grading, Filling, etc.)
kler System (Fire)
her:
Fee 5 (After -the -fact Investigation
The undersigned hereby acknowledges receipt of this limited
permit, Including acceptance of as special information.
terms, conditions or requirements written above. The
undersigned undenlands and agrees under penalty of law
that this permit Is strictly limited in scope to the work,
activity or Improvement asseelfled; that this permit does
not pant MY authority to do work or activities requiring
separate Permit approvals; and that the permit does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. Aa work shall be
done In strict compliance with all City ordinances, building
co6es and/or health department regulations, and shall be
sublet! to Inspection, approval or refection by the City.
Whenever an ordered, fit* undersigned agrees to cornet
any work found to be In violation of the conditions of
this permit.
Signature,of Applicant
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee S
Fee S
Fee S
Fee
S
Fee
S
Fee
S
Fee
S
Fee S ,5
Fee S _,391 Js,C
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City
Code: White -File Copy Canary Inspector's Copy Plrk-Finance Copy Gold -Applicant's Receipt