HomeMy WebLinkAbout1985-08-12 Permit, Sewer Connect #8030CITY PERMIT NO. 8030
GENERAL PERMIT
CITY OF ORONO Date
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner 01-9 Address �7 2't-/'I_/ RU
Contractor N e aAddress
City License No. �L State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
Water Meter (Size—)
Meter#
Remote
Municipal Water Connection
❑Copper a
Municipal Sewer Connection
C�f VC ❑ Cast
MWCC SAC Charge
On Site Septic System
NEW ❑ ADDITION
Fee S
Fee S
Fee S
❑ REPAIR
Water Well
Mechanical Equipment
Moving 'Lifting Builnings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S moo IFire
n
Fee S _
kler System (Fire)
Fee S lAfter-the-fact Investigation
ACKNOWLEDGEMENT I TOTAL
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions or requirements wdtten above. The
undersigned understands and agrees under penalty of law
that this permit is strictly Welted 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 taw, rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
codas snd/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.
Sign re of Applicant
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Fee $
Fee S
Fee $
Fee $
Fee
S
Fee
S
Fee
S
Fee
$
State
Surcharge: Fee $ , S0
Total Amount Paid to City Fee Sr&'
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature pf City Offici
Code: White —File Copy Canary --Inspector's Copy Pink —Finance Copy i Gold —Applicant's Receipt