HomeMy WebLinkAbout1986-05-08 Permit, Curtain Drain #8457GENERAL PERMIT CITY PERMIT NO. 8457
CITY OF ORONO
P.O.BOX 56 Date j
CRYSTAL BAY, MINNESOTA 55323 `
16121473-7357
Owner ia eFe o 4X -Address
Contractor
City License No.
REMARKS AND SPECIAL CONDITIONS
dAA. a..ci_ n (,a It j
PERMIT TYPE. AND FEE
Inside Plumbing (#fixtures_)
Water Meter (Size—)
Meter#
Remote N
❑ NEW ❑ ADDITION
Fee S
Fee S
Municipal Water Connection Fee S
❑Copper
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast
MWCC SAC Charge Fee S___
On Site Septic System
ACKNOWLEDGEMENT
Address
State License No.
❑ REPAIR
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fire —_
Sprinkler System (Fire)
Fee S IAfter-the-fact Investigation
The undersigned hereby acknowledges receipt of this limited
permit, Including acceptance of Alispecial Information.
terms, conditions or requirements written above. The
undenlgned understands and agrees under penalty of law
that alis permit is strictly Limited In scope to the work,
activity u. improvement specified: that tuts permit doe,
not grant any authority to do work or activities repuiri ig
sePara
te pe.i�" approvals: and that this permit does not
Rant autbOYlLY to violate any provision of any City
ordinance or State law, rule or regWatlon. All work stall be
done in strict compliance with all City ordinances, building
codes and,or health department re"UOns, and shall be
suWect to inspection, approval or relection by the City.
Whenever so ordered, the undersiyied agrees to correct
any work found to be in violation of the conditions of
this permit.
Signature o
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee S
Fee S
Fee S 5-0. ad
Fee
S
Fee
S
Fee
S
Fee
S
Fee S
Fee S so. S-0
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of Ci Official
�J
Code White-FdeCopy Canary Inspector's Copy Pink - Finance Copy Gold Applicant's Receipt