HomeMy WebLinkAbout1984-7288 - Water Meter GENERAL PERMIT CITYYERMITNO. __—�`ZgBI
CITY OF ORONO -
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(61�) 473-7
Owner �-�U Address l � � /Lt- � �
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Contractor Address
City I_icense No. State License No.
REMARKS AND SPECIAL CONDITIONS
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PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR
lnside Plumbing ( # fixtur�s ) Fee $ On Site Septic System Fee $
Water Meter (Size� ) Fee $�� Water Well Fee $
Meter �# �� ���� � �
Mechanical Equipment Fee $
Kemote#
Municipal Water Conn�ction Fee $ Moving�Lifting Buildings Fee $
❑Copper ❑ Land Alteration (Excavation, Fee $
Grading, Filling, etc.)
Municipal Sewer Conn�ction Fee $
❑ PVC ❑ Cast n Otlier: Fee $
MWCC SAC Charge Fee $ After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all specia] information,
terms, conditions or requirements written above, The
undersigned understands and a�ees under penalty of law State Surcharge: Fee �
that this permit is strictly limited in scope to the work, �,r-
activity or improvement specified; that this permit does J
not grant any authority to do work or activities requiring Total Amount Paid to City F0e �
sepazate permit approvals; and that this permit does not
grflnt 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 department regulations, and shall be TY11S pe277l1t 1S 110t Vd11C� Ulltll tlle pl'OpeI' tf'e iS pd1C� i1RCl
subiect to inspection, approval or reiecuon by the c�cy. it is approved by an authorized City Official.
Whenever so oxdered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signature of Applicant Signature of City O �c� 1
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Code:White—I ile Copy Canary—Inspector's Copy Pink—I�inance Copy Gold—Applicant's Receipt