HomeMy WebLinkAbout1982-12-21 Permit, Sewer Connect #6908GENERAL PERMIT CITY PERMIT NO. --6908 I
CITY OF ORONO
66 Date IZIlk-
P.O.BOX
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner A ()Q-tl. Address �� f ac KIidi-IJ _
Contractor & AiL o. L%jV - Address '—LCJ 8 341Nau
City License No. __�lo �f L�� State License No. 1 u
RLMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION
Inside Plumbing ( # fixtures ) Fee $
Water Meter (Size )
Meter #
Remote #
Fee $
Municipal Water Connection Fee $
[]Copper ❑
Municipal Sewer Connection Fee $_
❑ PVC 0 Cast ❑
MWCC SAC Charge Fee $ , o J
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
permit, including 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 permit approvals; and that this permit does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. All work shall be
done 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.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Si$natu of (plic t
G
❑ REPAIR
On Site Septic System Fee S
Water Well Fee S
Mechanical Equipment Fee S
Moving/Lifting Buildings Fee S
Land Alteration (Excavation, Fee S
Grading, Filling, etc.)
Other: Fee S
After -the -fact Investigation Fee S
TOTAL
State Surcharge: Fee S . 50
Total Amount Paid to City Fee S 1/yr. fQ
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
Code: White -I'de Copy Canary Inspector's Copy
Pink I tnance Cop> Gold Applicant's Receipt