HomeMy WebLinkAbout1986-06-05 Permit, Water Meterr
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P.O.BOX
CRYSTAL BAY. MINNESOTA 55323
(612)473-7357
CITY PERMIT NO.8503
Date__^>7 5/^
Owner
G«ntri*etor
City License No
________________ State License No.
rhmakks anr special conritions
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PERMIT TYPE AND FEE:
Inside Plumbing (#tiyures—)
Water Meter (Si/e_^ g^i
Meter# .,^ V’ .W
Remote
Municipal Water Connection
Q Copper CL
□ new □ addition □ repair
Fee S---------------
L.. s
Vlunicipal SevNcr Connection
Q pVC D Cast Cl
MWee S.\C Charge
On Site Septic S\stem
l ee S
Fee S
Water Well
Mechanical Equipment
Moving / Lilting Buildings
Land Alteration (Excavation,
Grading. Filling, etc.)
Fee S-- -
Fee S----
Fee $ ■
Fee S.
Fee S.
Fee S.
I ire
Sprinkler System (Fire)
Other:------------------
Alter-the-fact Investigation
Fee S.
Fee S.
Fee $
Fee $
acknowledgement
Th» undrni«n»<l ‘*"**”' *^ ipeci»l intonnitton.
prrmll. Including wdtun •bo»«. Th«
condltton* p«n.lty of l.«
undcnlgncd ^JJfJTd In tcopt to lh« wo»k.
th*t Oil* pcnnlt * ,p,cin»d; U»*« diU pennit doct
activity Of dnptovciMnt W ,cti»IU«t ryquiftnf
not gnutt any ^ Uut permit do« not
..parau ponnit ol ».y City
pant authoiity U> vli^ „,uUUon. AU work thaU be
ordlnanee oi State aw. ordinances, budding
don. in stnet »*a *•“ "•
code. M.d/of health <*«*“*”*?' "^“uon by the City,
•ubtect to inapectlon. •^.V^denlgned agrees to cotiacl
rn^Tf^^t rou^’^'t?. be in vIoUUon o. the condfUon. ol
thu p»nml.
TOTAL
State Surcharge:
Total Amount Paid to City-
Fee S,
Fee S ‘75.^
SifiiatuK ot Applicant , > y y
a-
Signature ol City-Off^al ^ .
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