HomeMy WebLinkAbout1985-8257 (SAC) GENERAL PERMIT CITYPERMITNO. g25� �
CITY OF ORONO Date ' � � � --��"
r.O.EOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
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Owner � Address
Contractor / Address
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
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 $
Land Alteration (Excavation, Fee $
Municipal Water Connection Fee $ - Grading, Filling, etc.)
❑Copper �
Municipal Sewer Connection Fee $ Fire Fee $
❑ PVC ❑Cast n � Sprinkler System (Fire) Fee $
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MWCC SAC Charge Fee $ � Other: Fee $
On 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 perxnit is strictly limited in scope to the work,
activity or unprovement specified; that this permit does �����
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 department regulations, and shall 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 agrees to conect
any work found to be in violation of the conditions of
this permit.
Signature of Applicant Signat e of City Offcial
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Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt