HomeMy WebLinkAbout1982-07-09 Permit, SAC #6738CITY PI:RMI� "°. --s73g i
GENERAL PERMIT
CITY OF ORONO
P.O.BOx 66 Datc
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner u%e Address /
Contractor Address
City License No.
REMARKS AND SPECIAL CONDITIONS
State License No.
-� L o-)g lu - S�_e r a!y� ado
PERMIT TYPE AND FEE: ❑ NEW
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter M
Remote #
Municipal Water Connection
❑ Copper
Municipal Sewer Connection
❑ PVC ❑ Cast r1
MWCC SAC Charge
ACKNOWLEDGEMENT
❑ ADDITION ❑ REPAIR
Fee $ I On Site Septic System
Fee $ I Water Well
Fee $
Fee $
Fee $
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 @hall 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.
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:
After -the -fact Investigation
TOTAL
Fee
S
Fee
S
Fee
$
Fee
$
Fee
$
Fee
S
Fee
$
State Surcharge: Fee S
Total Amount Paid to City Fee 4�,
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of Applicant -J - Sign t rc of CitY�0
ri•n, jL
Code: White -I ile Copy Canary Inspector's Copy oink Finance Copy Gold Applicant's Receipt
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