HomeMy WebLinkAbout1985-8262 (SAC) GENER
AL PERMIT CITYPERMITNO. szs� �
CiTY OF ORONO /�_ ��,
P.O.BOX 66 Date
CRYSTAL BAY,MINNESOTA 55323 �
(612)473-7357 i
Owner �� �dress�� �_1_����� . I
Contractor Address
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS ��
PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑REPAIR I
Inside Plumbing(#fixtures_) Fee $ Water Well Fee $
Water Meter(Size) Fee $ Mechanical Equipment Fee $ I'
Meter# Moving/Lifting Buildings Fee $
Remote,# '
Land Alteration (Exca.vation, Fee $
Municipal Water Connection Fee $ ,,
� Grading, Filling, etc.)
❑Copper -
Municipal Sewer Connection Fee $
Fire Fee $
❑ PVC ❑Cast � � rinkler System (Fire) Fee $
MWCC SAC Charge Fee $ ' Other: Fee $
On Site Septic System Fee $ After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
The underaigned hereby acknowledgea receipt of this limited
permit, iacluding acceptance of all spedal iaformatton, ,
terma, conditions or requirements wsitten aboGe. The
under�igned undexatands and agreea undes penaltY oP ]aw State Surcharge: Fee $_�
that this permit is affict1Y limited in scope to the work,
activity or impzovement speciffed; that thie permit dces ' ��
not �ant anY authorlty to do wark or activitiea reqviring Total Amount Paid to City Fee �
separate permit aPPxovals; and that this permit does not I
grent authoritY to violate anY Provieton oY any CitY �
ordinance ox State law,rule or regulation.AIl work ehall be �
doae ia stdet compltence with all CitY ordinancea,building
codes andlor health deHerta►ent xegulations, and ahall be This permit is not valid until the proper fee is paid and
aub3ect to insHect[on, approvel or re)ectlon by the CitY. it is approved by an authorized CiTy Official.
Whenever so ordezed, the uadezei�ed egreea to coaect
any work found to be in vlolation of the conditioae of
this permit.
Si ature of Applicant Signatu of City Offi ial
Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt
MINNEGASCO SERVr,ICE INSTALLATION
� Map No. Natural Gas � Pr�pane Vapor ❑ Permit No.
. Municipality ��.�.:���� Minneapolis � Order No. � �'�'� �`'�
Folio No. Date Ord'sred � "'�' =x'�� E No. �
Custorner's Name s�e1� �a P,�-�?��.�.•`„-i-� ��`' „i�;71���`tl-=i�'unc Tel.
Installation Address ��"���`� ��'�-�����a` �`� Zip
Liri�. f`"�`=`:�lock " Addition '';'�-��' �
Method of Installation or Construction (including method of compaction
and excavation) will be in accordance with procedures as described in
Minnegasco Operations Manual,Section 500, "Excavating,Backfilling and
* Surtacing",the most recent edition on file with the permitting authority.
Install: Service Main Location
Additional Info.
Pressure Class
, Date Completed Foreman's Name
To the (City Engineer
(City Council
(Village Council
_ (Town Board
The Minnesota Gas Company hereby requests permissi4n to perform the work
indicated above.
MINNESOTA GAS COMPANY
` �.�(�! �-� �
, �--�,
(Chief Engineer)
�_
il
To the Minnesota Gas Company '�
Permission is hereby granted the Minnesota Gas Company to perform the work
indicated above.
,� ' p
�__.
- "- -�- + o f i :. �' '
Date �" ``�: �1�� By ' � ��' ., { � - '�- ,
� (Authorized Signature)
' Form 52 R 5178