HomeMy WebLinkAbout1986-8719 (Sewer Connection) GENERAL PERMIT CITY PERNIlT �o s 71�
CITY OF ORONO
P.O.BOX 66 ��Q /� ' ��r ��
� CRYSTAL BAY,I��IINNESOTA 55323
(612)473-7�7
Owner �� Addre� �� 1 c� ���l' �
Contractor � �f' - /L � i�r'l7�/1.91`31 �
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c�ty r.���No. a o� I �1�, �-or�� ��ed
REMARKS AND SPECIAL CONDTfIONS
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PERMIT TYPE AND FEE: � NEW ❑ ADDITION ❑ REPAIR ❑ REMODEL
Inside Plumbing(#fixtures ) Fee $ Water Well Fee $
Water Meter(Size ) Fee $ Mechanical Equipment Fee $
Meter# Fireplace/Wood Stove Fee $
Remote# Moving/I ifting Bu�dings Fee $
Municipal Water Connection Fee $ Land Alteration(Excavation,
Grading,Fi7ling,etc.) Fee $
� ��r � I�.sign Review Fee $
Munici al Sewer Connection Fee $ ��•��
Fire Fee $
PVC ❑ Cast ❑
CC SAC Charge Fee $ Sprinkler System(Fire) Fee $
Other. Fee $
On Site Spetic System Fee $
After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
State Surcharge: Fee $ ' �
The u�ersigned hereby acknowl�re�eipt of this liatited permit, ���(�
including acceptance of all special information, ternis, condifions or Tota1 Amount Paid to City F8E $
requirements written above. The undersigned understands and agrees
under penalty of law that this pemut is stricdy limited in scope to the work,
activity or improvement speci6ed;that this permit does not grant any
authority to do work or activities requiring separate permit approvals;and
that this permit dces notgrant authority to violate any provision of any City
o�a��a�e or smce�w,rule or regulafion.All work shall be done in strict '�permit is not valid unt�the proper fee is paid and it is approved
compliance with all City ordinances, bw7ding codes ac►d/or health b 8II au�lOt1ZCC�Cl �Cl�.
department regularions,and shall be subje�t to inspec;tion,approval or Y tY
rejection by the Ciry.Whenever so ordered,the undersigned agrees to
correct any work found to be in vialaGon of the conditions of this permit
Signature o�licant
� Signature o .City O�cial
s���!, �
Code: White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt