HomeMy WebLinkAbout03-13-1985 Permit, On-Site Septic SystemGENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
CITY PERMIT NO.784i
Dnt. 3-/3-^S~
Owner Address Z'K&O y^iR,/AJC,x>Cif^ //HZ
Cnntrnrtnr C^M iCfCJUyJ^ ArcSAt<Ar7 _______ Address /^h' ^f=c7/t^______________________
City License No-------------------------------------------------State License No.
REMARKS AND SPECIAL CONDITIONS
_____________^ ~ /or^tD 'tx A/v Z/Ioc }2SZD ^ P/C^aJ^/c-z-^
PERMIT TYPE AND FEE: ^]0[n EW □ ADDITION □ REPAIR
Inside Plumbing (^fixtures __)
Water Meter (Size__)
Meter#______________
Remote #.
Municipal Water Connection
OCopper n
Municipal Sewer Connection
□ pVC DCast Q.
MWCC SAC Cliarge
On Site Septic System
Fee S
Fee S
Water Well Fee
Mechanical Equipment Fee
Moving /Lifting Buildings Fee
Land Alteration (Excavation, Fee
Grading, Filling, etc.)
Fire Fee
Fee I?
1 ec 0
Fee .S
Sprinkler System (Fire) Fee
Other: Fee
After-the-fact Investigation FeeFee S '’7'^^
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
permit* Including acceptance of all special information*
terms* conditions or requirements w'tittcn above. The
undersigned understands and agrees under penalty of law
that this permit is strictly limited in scope to the work*
activity or improvement specified: that this permit docs
not grant any authority to do work or activities requiring
separate permit approvals; and that this permit does not
grant authority to violate any pro\ision of any City
ordinance or State law* rule or regulation. All work ^all be
done in strict compliance with all City ordinances, building
codes and/or health department regulations* and shall be
subject to inspection* approval or rejection by the City.
Whenever so ordered* the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Sigilpturc of Apt^jeant
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S.
Fee S.7-^
This permit is not valid until the proper fee is paid and
it is approved by an authonzed City Official.
Signature of City Official /
Code: Wliitc-rUc Copy Canaiy-Inspcctoi ’s Copy Pink-Finance Copy Gold-Applicant ’s Receipt