HomeMy WebLinkAbout1983-07-26 Permit, Water Meter #7074GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
CITY PE RMIT NO. “ 70?4 I
Date
Owner-----rri^^-rna.^ Ad.las. /S
Contractor-------___________________/^Vmbj^ Addrcs.s P/d^ Jd • “T
City License No.
REMARKS AND SPECIAL CONDITIONS
State License No.
PERMIT TYPE AND FEE:
Inside Plumbing ( # fixtures.
□ addition D REPAIR
)
Water Meter (Size^U)
I Meic. ~3ai4hU.4X
|f Remote# /OC’x^l ^Li liA /
Municipal Water Connection Fee $.
Fee S________
Fee
..opper
Municipal Sewer Connection
□ pVC GCast Q.
MWee SAC Charge
Fee S.
Fee S.
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S___
Fee S___
Fee S___
Fee S___
Fee S___
Other:.
After-the-fact Investigation
Fee S,
Fee S,
ACKNOWLEDGEMENT
Tht undtrtigned hereby ackn jwledgta receipt nt ihii limited
permit. Including ecceptence of all Bpecial Information,
terms, conditions or requirements written above. The
undersigned undersunds and agrees under penalty of law
that thU permit U stilcUy Umlud In scope to the work,
•ctivlty or Improvement specified; that this permit does
not grant any authority to do work or activities requiring
aeparau permit approvals; and that this permit does not
grant authority to %ioLate any provlaion of any City
ordinance or Sute law, rule or regulation AU work be
done In strict compliance with all aty ordinances, budding
codes and/or health department regulations, aid shall be
Mbiect to Inspection, approval or reiectlon by the Oty,
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditiurui of
this permit.
Signature of Applicant
TOTAL
State Surcharge:
Total Amount I’aid to City
Fee S.
Fee S.7S^
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signatj^of City Official /O
Code; Whlie-I U. Copy Canary-Inipeclor’i Copy Pink• I inance Copy <-Ja Appllcanf* Receipt