HomeMy WebLinkAbout1984-12-04 Sewer & Water Connection #7743GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
t 612) 473-7357
Owner
Contractor t,tirl��) nGi
City License No.
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REMARKS AND SPECIAL CONDITIONS
CITY PERMIT NO. 7743
Date " -/ _ e-1?-1 I
Address 9 e
Address YZZ&
State License No.
PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing (#fixtures) Fee S d Water Well
Water Meter (SizeN Fee S . on Mechanical Equipment
Meter N
Remote #-- Moving /Lifting Buildings
Municipal Water Connection
❑Copper ❑
Municipal Sewer Connection
Fee S �• DOLL nd Alteration (Excavation,
Grading, Filling, etc.)
Fee S. :/�•Q� IFire
❑ PVC ❑ Cast a_
MWCC SAC Charge Fee S
On Site Septic System Fee S
ACKNOWLED :EMENT
Tha undersigned hereby acknowledges receipt of this limited
permit, Including acceptance of all special Information,
terms, conditions or requirements written above. The
underd=*d 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 doom not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. Ali work shall be
done in strict compliance with all City ordinances, building
cod" andlor health department regulations, and snail be
subject to inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit,
nkler System (Fire)
1
Fee $1
Fee S 1
Fee $1
Fee S 1
Fee S 1
Fee S I
her: Fee S
fter-the-fact Investigation Fee $
TOTAL
State Surcharge:
Total Amount Paid to City
Fee $/, S-n 1
Fee S
o? 7ST)
This permit is not valid until the proper fee is paid and I'
it is approved by an authorized City Official.
Signature of City Official
Code White - File Copy Canary -Inspector's Copy Pink -Finance Copy Gold -Applicant's Receipt