HomeMy WebLinkAbout1982-06-25 Permit, Sewer Connect #6726CITY PtRMITNO.--s"%`�,��
GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66 Date G
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner i ll/ �ddress
Contractor 1 �d Address
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: *NEW
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter # _
Remote #
❑ ADDITION
Fee $
Fee $
Municipal Water Connection Fee S
❑Copper n
State License No.
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Municipal Sewer ction Fee $ •L-
❑ PVC Co]`Cast ❑ Other:
MWCC SAC Charge Fee After -the -fact Investigation
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of at: special information,
terms, conditions or requirements wdtten above. The
undersigned understands and agrees under penalty of taw
that this permit is strictly limited in scope to We 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
Want authority to violate any provision of any City
ordinance or State law, rule or regulation. All work shall be
done to 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.
Signature of pplicant
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee S
Fee $ —
Fee $ —
Fee $
Fee $
Fee $ _
Fee $
Fee $
This pennit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Si Official
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Code White file Copy Canary -inspector's Copy
Pink —Finance Copy Gold Applicant's Receipt