HomeMy WebLinkAbout1984-10-30 App. & Permit, City Sewer Connect #7684GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL. BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 7684
Date ,-� - 3G �
Owner
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Address
Contractor
Address '� . '
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City License No.
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State License No. _
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REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_.)
Water Meter (Size �)
Meter #
Remote'}
Municipal Water Connection
❑Copper rl
Municipal Sewer Connection
❑ NEW
Fee S
Fee S
Fee S
❑ ADDITION ❑ REPAIR
ater Well
- (Mechanical Equipment
!Lifting Buildings
Land Alteration (Excavation
Grading. Filling, etc.)
Fee S _ e). (.IFire
PVC ❑Cast El — Sprinkler System (Fire)
MWCC SAC Charge Fee S�_ �- (Other:
On Site Septic System
ACKNOWLEDGEMENT
Fee S (After -the -fart Investigation
The undersigned hereby acknowledges receipt of this limited
permit, inrludina acceptance of all special information,
terms, conditions of 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 don
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
ordinanre or State law, rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
codes and/or health depertment 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 f App 'rant
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TOTAL
Fee S
Fee S
Fee S
Fee S
Fee
S
Fee
S
Fee
S
J
Fee
S _-
State Surchafgc: Fee SS/
Total Amount Paid to City Fee,�
This pemtit is not valid until the proper fee is paid an
it is approved by an authorized City Official.
Signature of City O icial
Code 4ite Idle Copy Canary Inspector's Copp Pink Finance Copy Gold Applicant's Receipt