HomeMy WebLinkAbout1984-10-16 Permit, Sewer Connect #7664GENERAL PERMIT
CITY OF ORONO
P.O. BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 7664
Date _1&L- -
Address Ay> U�E'E ST .+11
Contractor tCMWk-A .5:f U—) Address _ 4tWAJ >
City License No.
REMARKS AND SPECIAL CONDITIONS
4 kh
State License No.
PERMIT TYPE AND FEE: 9NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing (#fixtures_)
Water Meter (Size _)
\later#
Remote #
Fi:e S Water Well
Fee S __ Mechanical Equipment
\1un:, i)tal Water Connection Fee S--
❑( tipper ❑
n0
\tuni�iltal Sewer Connection Fee S _
KI'V(. ❑Cast F_
.\I\k'( C SAC Charge Fee S _
On Site Septic System
V-K NOW LEDGEM ENT
ing /Lifting Buildings
Land Alteration (Excavation
Grading, Filling, etc.)
Fee $ 1
Fee S 1
Fee S
Fee S_._J
ire Fee $__I
nkler System (Fire)
her:
Fee S IAfter-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 &vets under penalty of law
that this permit is strictly limited in scope to the work,
activity rr Improvement specified: that this permit does
nttt grant any authority to do work or activities requiring
separate permit approvals: and that this permit don 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 ordlnancea, building
codes and/or health department regulations, and shall be
subject to Inspection, approval or rejection by the City.
Whenever ■o ordered, the undersigned agrees to correct
Anv work found to be in siolation of the conditions of
this permit.
Si_,n.itufr,f Applicants
State Surcharge:
Total Amount Paid to City
Fee $
Fee S _-_ J
Fee S
S Si
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
Code White I ile Cop) Canarn Inspector's ('op) Pink I inance Copy Gold Applicant's Receipt