HomeMy WebLinkAbout1986-8471 - SAC only GENERAL PERMIT CITYPERMITNO. g4�I�
CITY OF ORONO Date � � �
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner C 1� � Address T��fJ�-� C���`�� f� '
Contractor w`" �` Address ��`l f1�J�
City License No. 1��� State License No.
REMARKS AND SPECIAL CONDITIONS
� � -� ' _��/L3 ����
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 $
� Grading, Filling, etc.)
❑Copper
�� �(� Fire Fee $
Municipal Sewer Connection Fee � _�—.
�PVC ❑Cast � Sprinkler System (Fire) Fee $
MWCC SAC Charge Fee $ Other: Fee $
O11 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 requirements written above, The
undersigned understands and a�ees under penalty of law State Surcharge: Fee $ `
that this permit is stricUy limited in scope to the work,
activity or irnprovement specified; that this permit does ��j
not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ �" ' �
sepazate permit approvals; and that this permit does not
grant 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
codes and/or health depaztment regulations, and shall be This permit is not valid until the proper fee is paid and
subject to inspection, approval or rejection by the c�cy. it is approved by an authorized City Official.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signature f icant � Signature of City Of ial
�.'-P-.'L�� c��`_� ��� �a
Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt