HomeMy WebLinkAbout1983-08-29 Permit, Water Meter #7120GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
C IT PE RMIT NO. _ _ 7120 1
Date V/"? VT3
Owner Address
LL' n
Contractor �%Qi� ��_ Address
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND 1 F: 0 NEW ❑ ADDITION
Inside Plumbing( # fixtures ) Fee
ev
Water Meter (Size S ) Fee S %S
Meter # 2 z . C-�6e1
Remote# 034 /437Z
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Municipal Water Connection Fee S=
❑Copper ❑
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast n
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee S_
The unde si ined hereby acknowledges receipt of this limited
Permit. including acceptance of all special Information,
terms, conditions or requirements written above. The
undetmgned 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 ,f any City
ordin&M, or State law, rule or regulation. All work shall be
done In strl:t compliance with all City orctinances, building
codes and/or health department regulations, and shaU be
subkct to inspection, approval or refection by the City.
Whenever so ordered, ,hr undersigned agrees to correct
any work found to he to %iulatlon of the conditions of
this permit.
Signature of Applicant
Codc White rile f opy Canary Inspecittr's Cupy
❑ REPAIR
On Site Septic System Fee S
Water Well Fee S
Mechanical F-lrmpwent Fee S
Moving/Lifting Buildings Fee S
Land Alteration (Excavation, Fee S
Grading, Filling, etc.)
Other: Fee S
After -the -fact Investigation Fee S
TOTAL
State Surcharge: Fee S
Total Amount Paid to City Fer�-
This pennit is not Nalid until the proper fee is paid and
it is approved by an authorized City Official.
is
Pink i inamc Copy Gold Applicant's Receipt