HomeMy WebLinkAbout1982-08-30 Permit, SAC #6784CITY PERMIT NO. 67g�!
GENERAL PERMIT
CITY OF ORONO
P.O.BOx 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner 422V�ee.-,, Address /._XJJ /`' ,e
Contractor — Address
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: NEW ❑ ADDITION
Inside Plumbing ( # fixtures ) Fee $
Water Meter (Size )
Meter #
Remote #
Fee S
Municipal Water Connection Fee $
❑ Copper ❑
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast ❑
MWCC SAC Charge Fee J op
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 grant any authority to do work or activities requiring
separate Permit approvals; and that this permit does not
grant authority to etiolate any provision of any City
ordinance or State law, rule ar regulation. All work shall be
done In strict compliance with all City ordinances, building
codes and/or hearth department regulations, and shall be
subject to inspection, approval or rejection by the Citv.
Whenever ao ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signature of Applicant /
C
❑ REPAIR
On Site Septic System Fee
Water Well Fee $
Mechanical Equipment Fee $
Moving/Lifting Buildings Fee $
Land Alteration (Excavation, Fee $
Grading, Filling, etc.)
Other: Fee $
After -the -fact Investigation Fee $
TOTAL
State Surcharge: Fee S
Total Amount Paid to City Fee S
i�
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official
Sig i r of City Offi ial
JJ .i
Code: White File ( upy Canary -Inspector's Copy Pink Finance ( opy Gold —Applicant's Receipt