HomeMy WebLinkAbout1984-11-27 Permit, City Water Supply Connection #7733GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 7733
Date _ I / ty 7 ey {
Owner.aj-V_C-� Address 3-Y/57
City License No. 0?0a J State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (Mixtures_)
❑ NEW ❑ ADDITION
Fee S
Water Meter (Size_) Fee S
Meter#
Remote $
❑ REPAIR
ater Well
Mechanical Equipment
/Lifting Buildings
Municipal Water Connection Fee S 4Z Land Alteration (Excavation,Grading, Filling, etc.)
❑Copper
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast n
MWCC SAC Charge
On Site Septic System
ACKNOWLEDGEMENT
Fee S
ire
Sprinkler System (Fire)
Fee S lAfter-the-fact Investigation
The undeadWil hereby acknowledges recolpt of this limited
permit, including acoeptanae of all special Information,
tents, conditions or requirements wdttan above. The
undardaned understands and agrees under penalty of law
that Shia permit is strictly timiled in scope to the work.
activity or hop eovemant rpeeifled; that " permit dome
not pant any authostlw to do work or activities revildne
espante permit approvals; and that this permit does not
VMS authority to violate say provision of any city
Ordinance or State law. rule or regulation. AN work, shut be
done In strict compliance with all City ordinances, bulMnS
code and/or bealth department rogulaticaa, and shill be
subject to inspection. approval or rejeetion by the City.
Wbenever so Ordered. the undersigned agrees to eoneet
any work found to be in violation of the conditions of
"permit.
Si ture of Ap cant
v
7r
TOTAL
State Surcharge:
Total Amount, Paid to City
Fee S
Fee S
Fee $
Fee S
Fee $-
Fee S
Fee S
�l
Fee S
Fee S -S'0
Fee S3d.sn
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of -Ifrcial
Code: White —File Copy Cmiary—Inspector's Copy Pink —Finance Copy Gold—AppUcant's Receipt