HomeMy WebLinkAbout1987-07-23 Permit, Water Connection #9142GENERAL PERMIT CfrY PERMIT NQ 9142
CITY OF ORONO
PO. BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner 1' ) _ Address
Cottttact(. ktn 11�d- (,J �' / JOv Address
City License No. Q City / `4 / I
REMARKS AND SPECIAL CONDITIONS
n . ,
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures —)
Water Meter (Size _—)
Mt ter #
Remote #
NEW
re: $
Munici Waterion Connect
Copper ❑ _ —
Municipal Sewer Connection
Ya PVC ❑ Cast ❑
MWCC SAC Charge
On Site Spetic System
ACKNOWLEDGEMENT
Fee S
❑ ADDITION
Fee C%v
Fee S C'u
Fee S
Fee S
The underagtned herrtn at knowiedgec reveilrt tr( this limited permit.
inc-tiding nxxpurxY tit all %rxcal mkxmau:m. term.. xidiu,ro tx
rNwrertx,,..s written abow rht arikin ned urdmtaneis and agrees
under remit cot law that this permit is anttly limited in scone U, the sstxk.
attisit) tx tmprnsement 9voriied. that this F met dtx.., rdtt grant a+,y
sutlx'ntvtndowtxk ractisttiesreytanmi
ngwriaratepertapprose6,and
than pd(x'% not grant atghmliit) %v*tcam, pnrsitawc{amCii%
txdrtarxe tr State late rule tr reprlatitxt All Mirk shall he done to strict
comrWrx-e with all City twdirtomm huikttng txxes . t.Utr health
department regulaurm.. and shall 1- "kw'—t 'nspecti m; apprnsal or
rret urn by the Cit,, Wherw%er sit order,' undcrvgned agreve• w
evxrttt am wtxk krurd to he to mAstWn t e t crdiu.rts ofthts permit
Signature of A icant
Water Well
❑ REPAIR
Mechanical Equipment
Fireplace/Wood Stove
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Design Review
Fire
Sprinkler System (Fire)
Other.
After -the -fact Investigation
TOTAL
Mate Surcharge:
Total Amount Paid to City
❑ REMODEL
Fee S _ —
Fee S
Fee S _
Fee $
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
Fee SZ,�
Fee $ 6 1 ' 60
0-16- L 1 61-;, �
Tiris permit is not valid until the proper fee is paid and it is approved
by an authorized City Official.
Signature of City Offitial
0 010
Cede White- File Cop, ('anan lmrirctdr's Cups
link—Fnarim Copy Gold— AppWw's Receipt