HomeMy WebLinkAbout1986-03-05 Permit, Land Alteration #8373GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(61 2) 473-7357
Owner Aokd_ J
Contractor ��% f u/7LQ1 �-rti%•
City License No,
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
CITY PERMIT NO. 8373
Date 3kj U(/
Address L o F /_e&4cA
Address T • O. Ax
❑ NEW ❑ ADDITION
Fee S
Water Meter (Size _) Fee S
Meter#
Remote #
Municipal Water Connection Fee S
❑Copper n
Municipal Sewer Connection Fee S
❑ PVC ❑ Ca,t ❑
MWCC SAC Charge
On Site Svptic System
ACKNOWLEDGEMENT
Fee S
Fee S
The undersigned hereby acknowledges receipt of this limited
permit. including acceptance of ail 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 activid" requiring
separate permit approvals; and that this permit does not
grant authority to violate trey provision of any City
ordinance or State law, rule or regulation. Ali work shall be
done in strict compliance with W City ordinances, building
codes and/or health department regulations, and shall be
abject 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
snit.
u of Applicvlt_�
�t / ) IL C_ L 4k..
State License No.
❑ REPAIR
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
ire
kler System (Fire)
Fee S I
Fee S I
Fee S
Fee S o'
Fee S I
Fee S I
er: Fee S I
er-the-fact Investigation Fee S I
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee S
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Off ial
C��
Code:White- FileCopy Canary - Inspixtor's Copy Pink -Finance Copy Gold -Applicant's Receipt
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