HomeMy WebLinkAbout1986-06-25 Permit, Water Meter #8541GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner / I �i !v ! . -1
Contractor 1, '
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION
Inside Plumbing (#fixtures_) Fee S
Water Meter (Site Fee S
Meter # - ''G ,,� L" /
Remotr'(__
Municipal Water Connection Fee S
❑Copper ❑
•
Municipal Sewer Connection Fee S _ .
❑ PVC ❑ Cast F_
MW(V SAC Charge Fee S
On Site Septic System
ACKNOWLEDGEMENT
CITY PERMIT NO. 8541
Date _ 2(
t l
Address �_' r � � (,• ►. '
1'
Address y �Yl h Y h
State License No.
❑ REPAIR
Water Well
Mechanical Equipment
Moving Lifting Buildings
Land Alteration (Excavation,
Grading. Filling, etc.)
Fee S
Fee S
Fee S__
Fee S
ire Fee S '
nkler System (Fire)
Fee S
her: Fee S
Fee 5 IAfter-the-fact Investigation Fee S __ I
The undersigned hereby acknowledges receipt of this limited
permit. including acceptance of W special Information,
terms, conditions or requirements written above. The
undersigned understands and sown under penalty of law
that " permit is strictly United In scope to the work,
activity or improvement specified; that this permit does
not grant any authority to do work or activities requiring
s "Pate permit approvals; and that this permit don not
Xt authority to violate any provision of soy City
ortAnance or State law, rule or regulation. Ati work shall be
!tme in strict compliance with fill City ordinances, building
cod" and/or health department regulations, and shall be
subject to u;:pection, approval or refection by the City.
Whenever so ordered. the undersigned agrees to correct
any worth found to be in lolation of the conditions of
this permit.
Signature ' pplicant '
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee S _ /
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signatury of City Off ial
Code While I de ( ups
Canar> Inspector's Cop)
Pink I inancc Cop) , / Gold Applicant's Receipt