HomeMy WebLinkAbout1986-8605 (Sewer Connection) �ENERAL PERMIT ��P�� N� s s o 5
CITY OF ORONO
P.O.BOX 66 Date �� ��_��
CRYSTAL BAY,NIINNESOTA 55323 �
(612)473-7357
Owner Address���� /'�� r �,
r� , /,. //
Contractor���u , _v1 S�� Addr��`�`� ��,�G�S/�� �C f / ��=
City License No. ��� City
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: � NEW O ADDITION ❑ REPAIR � ❑ REMODEL
Inside Plumbing(#6a�tures ) Fee $ Water Well Fee $
Water Meter(Size ) Fee $ Mechanical Equipment Fee $
' Meter# Fireplace/Wood Stove Fee $
Remote# Moving/Lifting Bu�dings Fee $
Municipal Water Connection Fee $ Land Altera.tion(Excavation,
O Copper ❑ Grading,F�ling,etc.) Fee $
Municipal Sewer Connection Fee $ ��� �ign Review Fee $
` / Fire Fee $
�J PVC�t ❑
�' Sprinkler System(Fire) Fee $
MWCC SAC Charge Fee $ Other. Fee $
On Site Spetic System Fee $ � �
After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
State Surcharge: Fee $ ��
The undersigned hereby acknowl� receipt of this limited permit, ��
including aaxpmnce of all special information, terms, condidons or Total Amount Paid to City Fee $ ��'�
reqwrements written above. The undersigned understands and agrees
under penalty of Iaw that this permit is strictly limited in scope to the work.
aciiviry or improvement specifietl;that this pertnit dces not grant any
authority to do work or activiues requiring sepa�ate permit approvals;and
ttiat this pertnitdces notgrantauthority to violate any provision ofany City
ordirtance or State law,nile or regulation.All work shall be done in strict '�pe�t is not valid unt�the proper fee is paid and it is approved
compliance with all City ordinances, bm7ding codes and/or health b an authorized Ci ��Cl�.
department regulabons,and shall be subject to inspection,approval or y ry
rejection by the City.Whenever so ordere�,the undersigned agrees to
correct any work found to be in violadon of the conditions of this permit.
Signature o �pplicant
� Signature of City O�cial
�_ .� .
� �
Code: White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt