HomeMy WebLinkAbout1985-05-13 Permit, SAC #7915GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner ✓�
�] T
Contractor .�l`-'
City License No.
Q mP
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE ' ND FEE
Inside Plum' ing (#fixtures_)
CITY PERMIT NO. 7915
Date.. I
Address _ r>�U X)�
Address
State License No.
NFXV ❑ ADDITION ❑ REPAIR
Fee S lWater Well
Water Meter (Size _)
Fee
Meter# —
Remote #
_
Municipal Water Connection
Fee
❑Copper ❑
Municipal Sewer Connection
Fee
❑ PVC ❑ Cast n
MWCC SAC Charge
Fee
On Site Septic System
Fee
ACKNOWLEDGEMENT
S ---
Mechanical Equipment
Moving /Lifting Buildings
S _
Land Alteration (Excavation,
Grading, Filling, etc.)
Fire _
Sprinkler System (Fire)
S -
Other:
S
After -the -fact Investigation
The undersigned hereby acknowledges receipt of this limited
Permit, including acceptance of W special tnf�rrnation,
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 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 of any City
brdinr ice or State law, rule or regulaUon. Ail work shall be
done In strict compliance with all City ordinances, bu.:''
codes and/or health department regulations, and shall be
subiect to inspection, approval or roection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signature of Applicant
TOTAL
State Surcharge:
Fee S
Fee S
Fee S
Fee $ 1
Fee S
Fee S
Fee $ 1
Fee S 1
Fee S_
Total Amount Paid to City Fee S 57, 6D
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
SignatureA City Offkal
(t c ;
Code: White -- File Cop•,
Canar> Inspet tor's Copy
Pink --finance Copy Go' i--Applicant's Receipt