HomeMy WebLinkAbout1986-8297 - general permit GE ��ERAL PERMIT �ITYPERMITNO. 829'7 �
. .,�
�V1�Y OF ORONO Date " �
- P.O.EOX 66
CRYSTAL BAY,MINNESOTA 55323
(612)473-7357
,
Owner �-� Address ` � � /
Contractor � � �� Address C% ��
City License No. State License No. / �I d7�f/7 c�
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 $
Municip 1 Water Connection Fee $�0' Land Alteration (Excavation, Fee $
� Grading, Filling, etc.)
Copper
Municipal Sewer Connection Fee $.
Fire Fee $
❑ PVC ❑Cast n Sprinkler System (Fire) Fee $
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 acceD�ce of ell aDecial informatlon, r,r�
terms, conditions or requirementa written above. The �(J
undersi�►ed understands and a�ees under Penalty of law State Surcharge: Fee $ �
that this permit is strictly limited in ncoDe to the work,
activity or imD�vement apecified; that this permit dcea �.�
not giant any authority to do w�k or activitiea requirtng Total Amount Paid to City Fee
sepazate Dermit approvals; and that this permit doea not
�ant auffiorlty to violate any provislon of any City
ordinance or State law,rule or regulation.All work shall be
done in strlct compliance with all CitY ordivances,building
codea �aior health deDartn►ent re�s�o�. �a �n8u be This permit is not valid until the proper fee is paid and
subiect to inaDection, apvroval or reiectlon by the CitY. it is approved by an authorized City Official.
Whenever so ordered, the undersigaed a�eea to correct
any work 4ound to be in violatdon of the conditiona of
this permit.
Si ature� of Ap lic nt Signature City Offici
. � �
Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt