HomeMy WebLinkAbout1985-05-17 Permit, Water Meter #7921GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 7921
Date
Owner f--V/-5&7A Address S- 4+wde7i�621-
Contractor Address 6
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City License No.State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION
Inside Plumbing Ofixt}�res_) Fee S q
Water Meter, Size•Jfq—G�} Fee S
Meter#
Remote $ // 9- TV 77[0
Municipal Water Connection Fee S
[Copper ❑
Municipal Sewer Connection
❑ PVC ❑ Cat
MWCC SAC- Charge
On Site Septic SYF"-Til
ACKNOWLEDGEMENT
❑ REPAIR
Water Well
Mechanical Equipment
!Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee
S
Fee
S
Fee
S
Fee
S
Fac S _- ----
Fire Fee S
n
Fee S _
nkler System (Fire)
her:
Fee S After -the -fart Investigation
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 this permit is strictly limited in scope to the work,
activity or improvement specified: that Uds permit does
not pant any authority to do work or activities requiring
separate permit approvals: and that this permit does not
pant authority to violate any provision of soy City
ordinance or State law, rule or regulation. Ali work shall be
done in suiet compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subject to inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be In violation of the conditions of
this permit.
Signa(ure PLApplicant
TOTAL
Fee S
Fee e
Fee S
State Surcharge: Fee S _,
Total Amount Paid to City Fee S-915-, (IT-)
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City
Code: White - - File Copy Canary Inspector's Copy Pink -Finance Copy
L-0 CrN
Gold --Applicant's Receipt