HomeMy WebLinkAbout1985-8269 - general permit G
ENERAL PERMIT CITYPERMITNO. g269 '
CITY OF ORONO Date i� � -
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
vner �C�I_� . ��I� Address �!��� �l�l�Y� �� ,
>ntractor Address
ity License No. State License No.
EMARKS AND SPECIAL CONDITIONS
ERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR
ide Plumbing (#fixtures_) Fee $ Water Well Fee $
ter Meter (Size_) Fee $ Mechanical Equipment Fee $
Meter#
Remote# Moving �Lifting Buildings Fee $
inicipal Water Connection Fee $ Land Alteration (Excavation, Fee $
� Grading, Filling, etc.)
❑Copper
�nicipal Sewer Connection Fee $
Fire Fee $
❑ PVC ❑Cast n Sprinkler System (Fire) Fee $
WCC SAC Charge Fee $ ther: Fee $
n Site Septic System Fee $ After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions or xequirements written above. The �—
undersigned understands and agrees under penalty of law State Surcharge: Fee $
that this permit is strictly limited in scope to the work,
activity or improvement specified; that this perxnit does �,/��
not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ 'J' �'
sepazate permit approvals; and that this permit does not
�ant authority to violate any provision of any City
ordinance or State law,rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
�oaes �a�or health depaxtment regulations, �a snau be This permit is not valid until the proper fee is paid and
subiect to inspection, approval or reiection by the c�cv. it is approved by an authorized City Official.
Whenever so ordered, the undersigned a�ees to correct
any work found to be in violation of the conditions of
this permit.
Signature of Applicant Signature of City Off ial
c
r'� <�(/�.,.� OI'Y�� �
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Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt