HomeMy WebLinkAbout1983-09-29 Permit, Water Connect #7182GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. _ 71821
Date l ".21 B 3
Owner Cal /V b T i,t l2 I�y Address _,� 7 ,>/FG&yAPA/
Contractor Address _ SraiIVL lP.A+QK
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: XNEW
Inside Plumbing( # fixtures )
Water Meter (Size)
Meier # ?,27
Remote# na A
❑ ADDITION ❑ REPAIR
Fee $ I On Site Septic System
Fee $
two
Municipal Water Connection Fee S..�_
OCopperlVIL Q
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast rl
M JVC( SAC Charge
ACKNOWLEDGEMENT
Fee $
The undersigned hereby acknowledges receipt of this limited
Permit. !ncludknc acceptance of all special Information,
terms, conditionb 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 specified: that this permit does
not grant any authority to do wwk or activntles requiring
separate Perm approvals, and that this permit does not
grant authority to violate any provisten of any City
(wdlnsnce or State law, rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subject to inspection, approval or reketlon by the City.
Whenecrr so ordered, the ur derafgned agrees to correct
any work found to be in y olatlon of the conditions of
this permit.
gnature �oApplicant
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:
After -the -fact Investigation
TOTAL
Fee S
Fee $
Fee S
i
Fee $
Fee S
Fee S
Fee $
State Surcharge: Fe;- S
so
Total Amount Paid to City Fee S�
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City
*�kci
Code: White -hale Copy Canary - Inspector's Copy
t
r
Pink -Uinance Copy Gold-Applimt's Receipt