HomeMy WebLinkAbout1982-6703 - SAC Only ss-
�`: .,= CITY PHRMIT NO. ... s �3�
�= GENE AL PERMIT
:� M CITY I OF ORONO Oatr — -
�� P.O.BOX 66
'"�� CRYSTALi,BAY,MINNESOTA 55323 I'
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�K612)473•7357 �
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.Ownrr G►�_��_� Addreu
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Contractor Addreu
.^Cf� License No.
State L
icense No. !
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,: REMARKS AND SP ICIAL CONDITIONS '
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= PERMIT TY
PE AND EE: ❑ NEW ❑ ADDI'TION ❑REPAIR I
' lnside Plumbing( � fi tures ) Fee S On Site Septic System F a_—=--- �
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,�.Water Meter(Size� Fee S Water WeU � a
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Meter � L Mechanical Equtpment F a— '
:Remote 1� �
I � Moving/Lifting Buildings Fee S-- �
��,Municipal Water Connlection Fee 3
��w � (;] Land Alteradon(Excavauon, Fe S---<
�:�} , ::� �Copper ���� Grading,Filling,etc.) �
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�� Municip�I Sewer Conn� ction Fee S �"
'�� �, ❑PVC ❑C t n Other. Fe S_—.
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�`�5 M�AiCC SAC Charge Fee 5-��-- After-the-fact Investigation Fe S
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.����<.�� � ;� ..;.. TO'I'AL
��=:•ACKNOWLEDGEM
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� � : rb.+�a.�+�.a n�ar.�►o.4as••�ros or ms,n�aa
;ar �pe►ud4n� t� o[ �11 rp�d�l tafoanatlon.
`�C��`� 'r•. s�m°`sml.,;ooadlaoe. rwi�.m.oti ..,da.a .bov.. re. State Surcharge: Fee ��-
�z 4 yadtr�d � �nd �R+�+ uadtr Dm�b of Lr O
�i ' � � p�antt 4 atldetb ltmltsd in aop� w th� �oek. `',�,�
" :: •���.� ��`"� t 'p°��� ti"` '�' °eT�` °oi Total Amount Paid to City Fee S_�C�2�
44 �. nd O�t mt auf6 ty to do woefc or�etlNtlss r�V��L
;* Mpasat� W��t +� : md that t6fs W�1t doa� not
` �nt rtthodb W �olate r�r D�dm o! m7 Qt7 .
oedleasee or 84t�L .n+le or�Nktloa.A1L work ahatl be
dar 1n st�et�o�P�i�� �m�a�'°�°�C°s'�� This rmit is not valid untii the prope fee is paid and
eoe.. analo: 6..tm 1f.vartmme :.sWnon.. .nd .e.a n. Pe
.,,a.�s w m.v.�st�.� .vv� a n�+� � "u �'h'• it is approved by an authorized City OfGc�ial.
wib�ewes w I ih. w►aa�ad .O«. t.. eoa+ee I
" � voAt tound to 10 ciolatlon ot tl►� eondltloes ot
` .' . ;. Ws pumlt . ;
Signa:.�re of Applicant Signature of City i
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' te—I�ilo CopY C1nuY—�mt�CoPY Pfnk-1•'inaoce CoQy Gold—APP��t`s Reeeipt
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