HomeMy WebLinkAbout1982-04-27 Permit, Sewer Connect #6666GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
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Owner • 41 /j�tl,12 i-A C�
Contractor ,f�� !2 Z-ce 6-
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CITY PERMIT NO. 6669 '
Date
Address
Address 44 mil
City License No. �% State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE. AND FETE: NEW
Inside Plumbing( # fixtures-)
Water Meter (Size )
Meter # _
Rsmote #
SA(- -#E�6- 3
❑ ADDITION ❑ REPAIR
Fee $ 1 On Site Septic System
Fee $ 1 Water Well
Municipal Water Connection Fee $
❑Copper
Municipal Sewer Connection Fee $_
XPVC ❑ Cast n
MWCC SAC Charge Fee S
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions or requirements wdtten 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 requiting
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 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 conditions of
this permit.
Si OnateIoAp ica t
Mechanical Equipment
Moving/Lifting Buildings
L nd Alteration (Excavation,
Grading, Filling, etc.)
Other:
After -the -fact Investigation
TOTAL
State Surcharge:
Total Amount Paid to City
Fee
S
Fee
S
Fee
S
Fee
$
Fee
$
Fee
S
Fee
$
S �'f
Fee S
Fee S �2c' l
This permit is nit valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City O
Code White I de Copy Canary Inspector's Copy
Pink - I inance Cop> Gold Applicant's Receipt