HomeMy WebLinkAbout1986-04-10 Permit, Water Hookup #8411CITY PERMIT NO.
Date
GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY. MINNESOTA 55323
(612)473-7357
Owner tP// * 3^^ O Address -^3/ 0 -) C< S Q>
CnnUAjAitt S i C ^^^ress_______
City License No__________^__________________State License No.
8411
(lire /
rOlA) ^S3Ci
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE:
Inside Pluinbinj: (Ifixtures__)
^ NEW □a DDITIO □ REPAIR
I ee 5
Water Meter (Si/e
Meter# ___
)Fee S___ __
Remote 1
Municipal VN ater Gmnection
(tipper n
Fee S 30.
Municipal Sewer ronnectitm
□ pvt □(.1st Q
M\V( (• SA( Clurue
lee S--
()n Site Septic System
Fee $..
I'ee S__
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land .Alteration (Excavation,
(trading. Filling, etc.)
Fee $
Fee $
Fee $
Fee $
Fire
Sprinkler System (Fire)
Other:______________
After-the-fact Investigation
Fee $
Fee $
Fee S
Fee S
ACKNOWLEDGEMENT
The undeniftned hereby •clinimlrdie* receipt of this limited
pemiil. ificludint •rcepUyice of all special Informalion.
lcrm», ctmdiiion» >*r requirrmenU \%i1tten abme The
underaiAned understands and agrees under penalty of law
that this permit is strictly limited in scope to the worli,
activity or tmpruvement specified; that this permit dot*
not grant any authority to do v^ork or acUiidei raqutrtng
separate permit approvals, and that this permit doat not
grant authority Ut vtoUte any providon of any City
ordinance or State law. rule or regulation All work shall be
done In strict compliance with all City ordinances, budding
codes and/or health department regulatioiM, and shall be
niblect to Inspectioa. approval or reieetton by the City.
Whenever t4) ordeied. die underdgned agrees to correct
any work found to be in violation of the conditions of
this permit
lUTAL
State Surcharge:Fee S .3:0
To;al Amount Paid to City Fee $,33-b^)
H'miit is not valid until the proper fee is paid and
>roved by an authon/ed City Official.
Signature of (it> Of ficial
~lh/^))an ( lira
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