HomeMy WebLinkAbout1985-12-26 Permit, SAC #8259GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473.7357
Owner
Contractor
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures`)
Water Meter (Size
Meter#
Remote #_
CITY PERMIT NO. 8259
Date �- �S I
Address � � �� �1' Y __5O
❑ NEW ❑ ADDITION
Fee S
Address
State License No.
❑ REPAIR
er Well
1 Fee S IMcchanical Equipment
Municipal Water Connection Fee S
❑Copper ❑
Municipal Sewer Connection
❑ PVC ❑cast
MWCC SAC Charge
On Site Septic System
ACKNOWLEDGEMENT
Moving !Lifting Buildings
Land Alter^tion (Fxcavation,
-- Grading. Filling, etc.)
Fee S -- __— (Fire
Sprinkler System (Fir_)
^ 1 1
Fee S.f�%�'i t ther:___- - - -
Fee 5 After -the -fart Investigation
The undersigned hereby aeknowledips receipt of this limited
permit, including aceepWce of W special information,
teres, conditions or repulremonls written above. The
undersigned understands and algees under penalty of law
that this pertnit is strictly limited in scope to the work,
activity or improvement speeined: that this permit don
not grant any authority to do work or activities requiring
separate permit approvals; and that this permit don not
grant authority to violate any provision of any City
ordinance or Slate law, rule or regulation. Aa work $hall be
done in strict cosnphance with all City ordinances, building
codes and/or health deparlinent regulations, and shall be
subject to lnspa<tion, approval or rejection by the City.
Whenever so ordered, the undersianed agrees to correct
any wor: found to be in Aclation of the conditions of
this peon it.
Signature of Applicant
.01. �! r k, "f,
TOTAL
Fee
S
Fee
$
Fee
$
Fee
$
Fee S
Fee S
Fee $
Fee $
Sta:c Surcharge: Fee S
Total Amount Paid to City Fee S � t:
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signatyfie of City
Code White Idle Copy Canary Inspector's Copy Pink Finance Copy Cold -Applicant's Receipt