HomeMy WebLinkAbout1986-8429 (Sewer Connection) GENERAL PERMIT CITYPERMITNO. � 8429 �
CITY OF ORONO Date �-� � P��
P.O.BOX 66
CRYSTAL BAY,MINNESOTA 55323
(612)473-7357
Owner ��� Address _ ���� rl� __ � ��
Contractor � • Address
City License No. `�� State License No.
REMARKS AND SPECIAL CONDITIONS
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PERMIT TYPE AND FEE: NEW ❑ ADDITION ❑REPAIR
Inside Plumbing(#fixtures_) Fee $ Water Well Fee $
Water Meter(Size) Fee $ Mechanical Equipment Fee $
Meter#
Remote# Moving/Lifting Buildings Fee $
Municipal Water Connection Fee $ Land Alteration (Excavation, Fee $
❑Copper ❑ Grading, Filling, etc.)
Municip Sewer Connection Fee $
,o, �� Fire Fee $
PVC ❑Cast n 6� Sprinkler System (Fire) Fee $
MWCC SAC Charge ��� Other: Fee $
On Site Septic System Fee $ After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
The under�t�aed hereby acknowledgea receipt of thie limited
permit, including acceptance oP all epedal informatioa, ���
terms, conditiona or requiiements w�dtten above. The State Surchar e• Fee $ •
under�lgned undezatands and a�rees uader penaltq of law g •
that this permit is atrtetly limited in �ope to the work, `
activitq or improvement sAeciPied; that this permit doea �A
not gtant any authorlty to do wark or activitiea requiring Total Amount Paid to City Fee � 0-7�-�
sepazate permit aPprovals; and that thfs permit does not �
grant authozity to vlolate enY Pi'ovieton oP any CitY
ordinance or State law,rule or xegulation.All work shell be
done in strict compliance with aII City ordiaaaces,buiiding �
codes and/or health departmeat regulaf3oae, and shall be This permit is not valid until the proper fee is paid and
aub�ect to inapectioa. approval or xe9ection by the CitY. it is approved by an authorized City Official.
Whenever so ordered. the underaigned e�eea to correct
any work found to be in violatton oP the conditions of
this Permi�
Signature o Applicant Signature o City Off ial
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Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt