HomeMy WebLinkAbout1984-10-10 Permit, Land Alteration #7647GENERAL PERMIT CITY PERMIT NO. 7647
CITY OF ORONO ��� _ ICA _
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357 J
, Address
Owner �'l'� %� I S � e� ? �2
Contractor Address
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE:
Inside Plumbing (#fixtures_)
❑ NEW ❑ ADDITION
Fee S
Water Meter (Size _) Fee S
Meter#
Remote #
Municipal Water Connection Fee S
❑Copper
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast n
MWCC SAC Charge Fee S
On Site Septic System
ACKNOWLEDGEbI :NT
❑ REPAIR
ater Well
chanical Equipment
oving /Lifting Buildings
Grading,
Fire
(Excavation,
ig, etc.)
Fee S
Fee S
Fee S
Fee S
Fee S
Sprinkler System (Fire) Fee S
- Other: Fee S
Fee S lAfter-the-fact Investigation
The undersigned he,eby ack iowledges receipt of this limited
permit, including acceptance of ell special information,
terms, conditions or requirements written above. The
undersigned understands and agrees under penalty of law
that this permit is strictly limited to scope to the work,
activity or improvement specified: that this permit does
not Rent any authority to do work or activities requiring
separate permit approvals. and that this permit does not
Rant authority to violate any provision of any City
ordinance or Stag law, rule or regulation. Ali work shell be
done In strict compliance with all City ordinances, building
codes and/or health department regulations, and shell be
subject to Inspection, approval or relection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
S' ature f Applicant
L 6' >
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee S
Fee S
This permit is not valid until the proper fee is paid and I
it is approved by an authorized City Official.
Signature of City Official
Code: White -File Copy Canary --Inspector's Copy Pink- Finance Copy Gold —Applicant's Receipt