HomeMy WebLinkAbout1982-10-14 Permit, Sewer Connect #6848GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner %LS1.3 S"56 0
Contractor NESZQ �ayp+ M=Um
City License No,
REMARKS AND SPECIAL CONDITIONS
CITY PERMIT NO. 6848,
Date 10 —14 Z
Address
State License No.
PERMIT TYPE AND FEE: NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing ( # fixtures )
Water Meter (Size_.,,)
Meter #
Remote #
Fee S
Fee S
Municipal Water Connection Fee S
❑ Copper F1
Municipal Sewer Connection
❑ PVC j4Cast n
MWCC SAC Charge
.ACKNOWLEDGEMENT
v�•
Fee S
Fee $
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information.
terms, conditions or requirements written above. The
undersigned understands and agrees under penalty of law
that th4 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. AU work shall be
done in aW.ct compliance with all City ordinances, building
codes and/or MOO department regilations, and shall be
subject to Inspection, approval or tejection by the City.
Whenever so ordered, the undersigned agrees to correct
any worst found to be in violation of the conditions of
dds permit.
SignatuV of Applicant
( Re,
Code White - File Copy Canary Inspector's Copy
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fie $
Fre $
F -:e S
Fee $
=ee S
Other: Fee S
After -the -fact Investigation
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee $ IS -0 -
Fee $ 5, s0
This permit is not valid until the proper tet: is paid and
it is approved by an authorized City Official.
Signature,41' l
Pink F inance Cop'* (:old Apph,. nt's Receipt