HomeMy WebLinkAbout1982-04-23 Permit, SAC #6663GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 66631
Date �Z — - 3 — f- 2
Owner mil _ Address 0'a fd 64
Contractor
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FLE: ❑ NEW
Inside Plumbing I # fixtures I
Water Meter (Size—)
Meter
Remote #
0 ADDITION
Fee $
Fee $
Municipal Water Connection Fee $
❑Copper a
Municipal Sewer Connection Fee $
❑ Pvc ❑ cast
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee $ 4-'2,s
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 taw
that this permit is strictly limited in scope to the work,
activity or improvement specified; that this ;3. ioes
not grant any authority to do work or activities .ring
separate permit approvals; and that this permit ooes not
grant authority to violate any provision of any City
ordinance 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 rejection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the Londitions of
this permit.
SignaMW
et:
Address
State License No.
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:
After -the -fact Investigation
TOTAL
Stat,- Surcharge:
Total Amount Paid to City
Fee
5 _
Fee
$
Fee
$
Fee
$
Fee
$ _
Fee
$
Fee
$
Fee $
Fee $ . GD
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
14Aa-iLa
Jv-
Code. While I de Copy Canary Inspector's Copy Pink -I inance Copy Gold Applicant's Receipt