HomeMy WebLinkAbout1982-10-21 Permit, Sewer Hook Up #6854GENERAL PERMIT
CITY OF OftONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner .� /laGr �fi�uea� t d-.
Contractor
City License No.
REMARKS AND SPECIAL CONDITIONS
-.41-7
PERMIT TYPE AND FEE: X
NEW
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter #
Remote #
❑ ADDITION
Fee $
Fee $
Municipal Water Connection Fee S
❑ Copper ❑
Munici al Sewer Connection Fee
PVC ❑ Cast [1
MWCC S C Charge Fee $
ACKNOWLEDGEMENT
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 City
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 to ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signature ant
Code: White —File Copy Canary --Inspector'& Copy
CITY PERMIT NO. 6854,
Date fa - aw/_ 910
Address
Address r� Z?11
State License No. I% 124
Cl REPAIR
On Site Septic System Fee S
Water Well Fee S
Mechanical Equipment Fee S
Moving/Lifting Buildings Fee S
Land Alteration (Excavation, Fee $
Grading, Filling, etc.)
Other: Fee S
After -the -fact Investigation Fee S
TOTAL
State Surcharge.
Total Amount Paid to City
Fee S
si0
Fee fJ
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City ffj
Pink --Hnance Copy Gold Applicant's Receipt