HomeMy WebLinkAbout1985-08-21 Permit, Water & Sewer Connection #8051GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 8051
Date
Owner 11__ Address '
f n e 'C `_
Contractor Address --S)CIna IU
Ppu—
City License No. it State License No.
REMARKS ANY SPECIAL CONDITIONS
AIML. 1 jilt' G"tt-& MCI IV1 Ntic_
A
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
Water Meter (Si/e _ )
Meter#
Remote
Municipal Water Connection
Copper
Municip- Sewer Connection
❑ NEW ❑ ADDITION ❑ REPAIR
Fee S Water Well
Fee S -- Mechanical Equipment
Moving 'Lifting Buildings
Fee S
r (Land Alteration (Excavation,
_ .� _. _ grading, Filling, etc.)
Fee S C- Fire
PVC ❑ ('a,t F- Sprinkler System ( Fire )
MWCC SAC Charge Fee S . 4 Other:
On Silt: Septic System Fee S After -the -fact Investigation
ACKNOWLEDGEMENT
The undersigned hereby arknowirdges receipt of Wis limited
permit, including acceptance of all special information,
term,, conditions or requirements wdlten 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 th..r this permit does not
grant authority to vloisle any provieion of any City
ordinance or State law, rule or regulation. AU work shall be
done in strict compliance with all City ordinances, building
codes and/or health department regulations and shall be
subiect to Inspection, approval or rejection by the Citv.
Whenever so ordered. the undersigned agrees to correct
anv work found to be in violation of the condtt.ons of
this permit.
Signature of Applic,.r.t /
TOTAL
State Surcharge -
Total Amount Paid to City
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee S A 00 1
Fee S _ & CI
O I
This permit is not valid until the proper fee is paid and I
it is approved by an authorized City Official.
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Code White I ile Cup) (anar% Inq-:tor'% Copy Rnk I inane Cop) cold Appll:ant's Receipt