HomeMy WebLinkAbout1986-05-28 Permit, Municipal Water Connect #8485GENERAL PERMIT CITY PERMIT NO. 8485
CITY OF ORONO
Date 0 Re A,6
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner + - Address '1-16 96
Contractor Address % �� ✓ r
City License No. f Y7& State License No. `�� � —1
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: NEW
Inside PlumbingOfixtures_) Fee S
Water Meter (Size _1
Meter
Remote
Municlp• I Water Connection
&opper ❑
Municip 1 Sewer Connection
(PV(' ❑ Cast
MWCC SAC Charge
Ott Site Septic: System
ACKNOWLEDGEMENT
❑ ADDITION ❑ REPAIR
Fee S -- -
_ ,Water Well
-- Mechanical Equipment
oving %Lifting Buildings
Fee S C, C� ,Land Alteration (Excavation
Grading, Filling. etc.)
I
Fee
S
Fee
S
Fee
S
Fee
$
Fee S �(o `',Fire Fee S I
Fee S
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions or requirements wdtten above. The
undersigned understands and agrees under penalty of law
that this permit is strictly limited in scope to the work,
aeUvity or improvement specified: that this permit does
not gent any authority to do work or activities requiring
separate permit approvals: and that this permit dote not
grant authority to violate any provision of any City
ordlnancr or State law, rule or regulation. Ali work shall be
done in strict compliance with all City ordinances, building
codes and/or health department regulations. and *hall be
subiect to ktspeetlon, approval or refection by We City.
Whenever so ordered. We undersigned agrees to correct
any work found to be in %iolation of the conditions of
this permit.
Signature o -40icant
i /• , �ji, �/.tr �
rinkler System (Fire)
- - (Other:
r-the-fact Investigation
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee S 1
Fee S 1
Fee S '
Fee S
This permit is not valid until the proper fee is paid and I
it is approved by an authorized City Official.
Signature ojcity Official
( ode White I lie copy Canar) Inspector's Cop) Pink I inane t opy {send Applicant's Receipt