HomeMy WebLinkAbout1982-09-22 Permit, Water & Sewer Connect #6820CITY PERMIT NO. —682,
GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(6 12) 473-731I57``
Owner irm. NEt Address �`7 � CF V R � et A 51 Or
Contractor 1 `7 Address r �00
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: XN EW
Inside Plumbing ( # fixtures )
Water Meter (Size
Meter # _
Remote # _
❑ ADDITION ❑ REPAIR
Fee S
Fee S
Municipal Water Connection Fee S a� w
,Copper
�n
Municipal Sewer Connection Fee $ 0,
❑ PVC Wast n
nr�
MWCC SAC Charge Fee $ja ,
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of c ,_, y %-.atlon,
terms, conditions or requirements written above. The
undersigned understands and agrees under penalty of law
that this permit is strictly limited in scope to 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 City
ordinance or State law, rule or regulation. All work shall be
done In strict r'imuliance with all City ordinances, building
codes—.di,,, health department regulations, and shall be
subject to inspection, approval or rejection by the City.
Whenever so ordered, the andersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signature oy.Mp
Code: White—tile Copy Canary -- Inspector's Copy
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:
After -the -fact Investigation
TOTAL
Stat, Surcharge.
Total Amount Paid !() City
Fee S
Fee $
Fee $
Fee S
Fee $
Fee S
Fee $
Fee S /.00
oe
Fee $ _
This permit is not valid until the proper fee is paid and I
it is approved by an authorized City Official.
Signaturr.yf City
Pink I inance Copy (Iold Apphrant's Receipt