HomeMy WebLinkAbout1983-09-29 Permit, Sewer SAC #7181GENERAL PERMIT
CITY OF ORONO
t1.0.Box 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner
Contractor
('I'I ti' I'I:NMIT Nll. "%igi
Address 2 - -If "y C, CA g=m &t 61 Is -r -
Address
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
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.. * 951t C -
PERMIT TYPE AND FEE: XNEW ❑AUDITION
Inside Plumbing ( # fixtures_ ) Fee S
Water Meter (Size ) Fee S
Meter #
Remote #
Municipal Water Connection
OnCopper Q
Municip I Sewer ,of iectl0l)
Fee S It
Fee S 2-V-0-
PVC Cast
MWCC SAC Charge Fee S
ACKNOWLEDGEMENT
The undersigned hereby acknowledges jecelpt of this limited
permit, including acceptance of all special infc.rmation,
terms. conditions or requirements written above. The
undersigned understands and agrees under penalty of law
that this permit is strictly limited in scope tr the work,
activity or improvement specified. that this permit does
not grant any authority to do work or activities requiring
separate permit approvals; and that this permit does not
grant authority to violate any provision of any C.ly
ordinance or Stale law. rule or regulation. Ali work shall be
done in strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subieet to inspection, approval or reJection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in %jolation of the conditions of
this permit.
Si u re o Applicant
1 1
01
Code White I de Cup) Canard In%peL lia's Copt
❑REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling. etc.)
Other:
After -the -fact Investigation
FOTAL
State Surcharge:
Fee S
F=ee S
Fee S
Fee S
Fee S
E= cc S
Fee S
we,
Hee S • C 0
Total Amount Paid to City Hee S 4q180
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Slgnatl#,re of t'It� (4tt�clal
Pink 1 inancc Copt Gold Applicant's Receipt