HomeMy WebLinkAbout1986-10-17 Permit, Sewer Connect #8734GENERAL PERMIT
UITY OF ORONO
P.O. BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner nern�.
Contractor �� /? ,� r � C/ F_x C
City Limn No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE XNEW
Inside Plumbing (#fixtures ) Fee S
Water Meter (Size _—) Fee S
Meter #
Remote #
Municipal %ter Connection
❑ Copper ❑
Municipal Sewer Connection
APVC ❑ Cast ❑
MWCC SAC Charge
On Site Spetic System
ACKNOWLEDGEMENT
Fee S
CITY PERMIT N? 8734
Address KW .� f e S � am"
Address 2.2 o V crwon s
City k 4!:� re-71 114 k)
❑ ADDITION ❑ REPAIR
Water Well
Mechanical Equipment
Fireplace/Wood Stove
h1oving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Design Review
Fee S
Fee S
Fee S
fltr undersigned hereby acknowk m reeapi d this limited permit.
incldinit aLuTtance of all special irformawn. terms. conditions or
rNLiremem written mast. T%e understitnnl understands and agrees
under penaliv of law that this permit is gristly limited in scope to the work.
amity or improserrmrnt specified ihat this permit daes rat gent any
autfanty todo work or actisities requnng separate permit apprsah: and
that this permit does not p -,no a udxmty to Ciolate anv prImmon d any ('ity
ordinance or Sate law. rule r r regulaom. All work still he done to print
Compliance with all City ordi antes. building cedes and -'or health
department regulauceK and shall he subject to impmlion. approsal or
rejection by the City Wheoestr rk ordered. the urderdgned agree, to
correct ans work hxxd a, ne con sinhaoon ma the conditions of kits permit
Signat of Applicant^
Fire
Sprinkler System (Fire)
Other.
After the4act Investigation
❑ REMODEL
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
TOTAL
State Surcharge: Fee S 1 S�
Total Amount Phid to City Fee S 30, Sb
This permit is not valid until the proper fee is paid and it is approved
by an authorized City Official.
City Official
Qide: White- File Copy Cann Inspectors Cops Pink— Finance Cop) Gold-- Appliant's Receipt