HomeMy WebLinkAbout1986-06-11 Permit, Water Meter #8517GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner C, U, &) l l/ i Ca`/»
Contractor
City License No.
REMARKS AND SPECIAL CONDITIONS
CITY PERMIT NO. 8517
Date 6
Address / ( Fa ,
Address
State License No
PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing (# ixtures_)
Water Meter (Siz �O
Meter# a
Remote $
Fee S IMechanical
Water Well
-
Fee S �Equipment
Municipal Water Connection Fee S
❑Copper n
Municipal Sewer Connection Fee S _ _ -
❑ PVC ❑ Cast n
MWCC SAC Charge Fee S
On Site Septic System Fee S
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
permit, Including acceptance of all special Information.
terms, conditions or requirements written above. The
undersigned understands and agrees under penalty of law
that this permit is strictly limited in scope to the work,
activity or Improvement wecitied; 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 of any City
ordinance or State law. rule or regulation. All -:cork shall be
done In strict compliance with all City ordinances, building
codes andlor health department rt gulatlons, and shall be
subfect to inspection. approval or refection by the City.
Whenever so ordered. the undersigned agrees to correct
any work found to be in �iolatlon of the conditions of
this perrr.I*.
Signat of A \ lican
J
g /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fire
Sprinkler System (Fire)
Other:
Fee
S
Fee
S
Fee
S
Fee
S
Fee S !
Fee S
Fee S
r-the-fact Investigation Fee S
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee S LI-16 Q0
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City' Offo.'
x
Code White Ilk Copy Canary Inspextor's Copy Pink -Finance Copy Gold -Applicant's Receipt