HomeMy WebLinkAbout1982-07-12 Permit, Sewer Connect #6743GENERAL PERMIT CITY PFRMIT NO.--67431
CITY OF ORONO 7
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner f! �fti �° Address 2cS-
Contractor �� /� �� Address r�-{ a- a --
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter # _
Remote #
NEW ❑ ADDITION
Fee $
Fee $
Municipal Water Connection Fee
[]Copper n
Municipal Sewer Connection Fee
Q PVC ❑ Cast n
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee
State License No
t
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Al
Fee $
Fee $
Fee $
$
Moving/Lifting Buildings Fee
Land Alteration (Excavation, Fee
�� Grading, Filling, etc.)
$�
Other: Ft,e
$ After -the -fact Investigation 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 pant any authority to do work or activities requiring
separate permit approvals; and that this permit does not
pant authority to violate any provision of any City
ormnanee or State law, rule or regulation. All work s:uil 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 epees to correct
any work found to be in violation of the conditions of
this permit.
Sfi re of Applicant
l
TOTAL
State Surcharge:
Total Amount "aid to City
Fee $ .156
Fee S ' I
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
SigaLre f City Official
Code: White file Copy Canary Inspector's Copy Pink - I finance Copy Gold Applicant's Receipt