HomeMy WebLinkAbout1982-09-23 Permit, Water Hookup #6822GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(6 12) 473-7357
CITY PERMIT NO. 6822 1
Date 7 --t?P, -2-
Owner PAVC– q ��2-�ic1 cin Address kG t e��u #d
I
Contractor __WldmE2 E)rvA4 Address �` r t Nn �A1Z
City License No
REMARKS AND SPECIAL CONDITIONS
?J0\032 78,
R�ffu►e"r i Z C;., 3so V 7,5,
PERMIT TYPE AND FEE: ❑ NEW
Inside Plumbing ( # fixtures )
Water Meter (Size V)
Meter # 301632-77C
Remote# 12G3S475
❑ ADDITION
Fee S_
Fee $_L0
tie)
M^nicpa
'l Water Connection Fee S -01
Copper
:Municipal Sewer Connection Fee $
❑ PVC ❑ Cast Q—
M%%'CC SAC Charge
ACKNOWLEDGEMENT
Fee $
The undersigned hereby acknowledges receipt of this limited
permit, uicluding 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 this permit does
not grant any authority to do work or activities requiring
separate pennit 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
dune in strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subject to inspection,approval or rejection by the City.
Wbenever so ordered, the undersigned agrees to correct
any work found to be in violation of the eonditlons of
this permit.
Signature of Applicant
State License No.
❑ REPAIR
On Site Septic System Fee S
Water Well Fee S
Mechanical Equipment Fee S
Moving/Lifting Buildings Fei. $
Land Alteration (Excavation, Fee $
Grading, Filling, etc.)
Other: Fee S
After -the -fact Investigation Fee S
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S . Y(
JU
Fee S '/
This permit is not valid until the proper fee is paid and I
it is approved by an authorized City Official.
Signatur4 of City
Code: White file Copy Canary Inspector's Copy Pink --Finance Copy Gold - Applicant's Receipt