HomeMy WebLinkAbout1982-12-21 Permit, Sewer Connect #6909GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 6909 1
Date / a - A/ - 9.;7-
Owner Address _l :'� �� s /�' J,�r�>•n_ S�
Contractor rkf3, d Address -5' 0 &-23�4
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE. AND FEE: ❑ NEW ❑ ADDITION
Inside Plumbing ( # fixtures ) Fee S
Water Meter (Size )
Meter #
Remote #
Fee S
Municipal Water Connection Fee S
❑ Copper
Municipal Sewer Connection Fee S �U
❑ PVC ❑ Cast
MWCC SAC Charge
ACKNOWLEDGEMENT
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:
Fee SDI After -the -fact Investigation
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 ;aw
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 atrict compliance with all City ordinances, building
codes andlor 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 to violation of the conditions of
this permit.
Signatu of Ap licant
Code: ite—Pile Copy Canary- Inspector's Copy
TOTAL
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
State Surcharge: Fee S . S0
Total Amount Paid to City Fee S s• SU
This pennit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
Pink I inance Copy Gold Applicant's Receipt