HomeMy WebLinkAbout1983-12-05 Permit, Sewer Hook Up #7259GENERAL PERMIT
CITY OF ORONO
P.O.BOx 6o
CRYSTAL BAY, MINNESOTA 55323
61' 473 7'I57
CITY PFRMIT NO. 7259 1
Date 1 2 - s 43
1 _) -
Owner T)"A Qo!-,Kf�_— Address Ammss j-_
Contractor-STphkp `%Ewey- i Address P3 1 Y\CA Minn
City license No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE: AND FI:E: A61 F W
Inside Plumbing # fixtures )
Water Meter (Site )
Meter k
Remote #
❑ ADDITION
Fee S
Fee S
Municipal Water Connection Fee S
❑Copper Q_
ry
Municipal Sew-e:r Connection Fee S
XPVC ❑ ('as[ a
MWCCSAC Charge
ACKNOWLEDGEMENT
Fee S
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 Use nark.
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
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. Ali work allied be
done in strict compliance with as City ordinances, building
codes and/or health department regulations, and shall be
sub)ect to Inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agrees to correct
an) work found to oe its violation of the conditions of
this permit.
Signature ' pplicant ,.
State License No
❑ REPAIR
On Site Septic System Fee S
Water Well Fee S
Mechanical Equipment Fee S
Moving/Lifting Buildings Fee S
Land Alteration (Excavation, Fee S
Grading, Filling, etc.)
Other: Fee S
After -the -fact Investigation fee S
TOTAL
State Surcharge:
Total Amount Paid to City
20,
Fee S So
Fee S 20 -
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of ('ity Official
Code. White I Ile ( opy Canary lnspector's Copy Pink I inance Copy Gold Applicant's Receipt