HomeMy WebLinkAbout1982-06-25 Permit, Sewer Connect #6725GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
4 (612) 473-7357
Owner
Cwntractor
City License No.
REMARKS AND SPECIAL CONDITIONS
CITY PERMIT NO. 67215,
Date S" y,::1Z
Address
-Address n
PERMIT TYPE: AND FEE: j3J NEW ❑ ADDITION
Inside Plumbing ( # fixtures ✓ ) Fee $
Water Meter (Size ) Fee $
Meter # _
Remote #
Municipal Water Connection Fee S
❑ Copper n n
Municipal Sewer Connection Fee S
❑ PVC [dcast ❑
MWCC SAC Charge
ACKNOWLEDGEMENT
State License No,
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:
Fee S /v Eff After -the -fact Investigation
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 law
that this permit is strictly limited in scope to the work,
activity or improvement specified: that this permit does
not {rant 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 Citv
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
an) work found to be in violation of the conditions of
this permit.
Signature• elf' Applic, fit
TOTAL
State Surcharge -
Total Amount Paid to City
Fee
S
Fee
S
Fee
S_
Fee
S
Fee
S
Fee
S
Fee
S
Fee
Fee
This pemlit is not valid until the proper fee is paid and I
it is approved by an authorized City Official.
Sig t it of City Official
I
4A /11),J
Code: White -File Copy Canary Inspector's Copy Pink I inance (y)p) (,old Apphrant'v Receipt