HomeMy WebLinkAbout1983-09-26 Permit, Septic System Addition #7175GENERAL PERMIT CITY PERMIT NO. --71U
CITY OF ORONO v2
P -0 -BOX 66 Date t� -- J J
CRYSTAL BAY, MINNESOTA 55323
(612) 473-73
Owner �^ I_.l Address / 46 1 i/Oaf
Contractor /n.( L._ ( Address
City Licenar No. State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPF AND FEE: ❑ NEW ADDITION
Inside Plumbing ( N fixtures_) Fee S
Water Meter (Size_) Fee S
Meter M
Remole N
Municipal Water Connection Fee S
❑Copper ❑
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast n_
MWCC SAC Charge Fee 5
ACKNOWLEDGEMENT
The undantaned hanby Tran owledMa rettlDl of this limitedpermit, lncludbg eccep{arce of til pedal Inlorrnstlon,
terms, conditions o@ n•uinmenta scittt- above. The
underaged und@ntsnds and aspoes under penalty of raw
that thispared/ bi sbledy timlted in scope to the wort,
ac deity cr I-Prpvewent peeir d; that tbh permit does
and grant any wthosity to do work M actlNM
tles n•ung
sava"LP Permit approval; and that this permit does not
Qant aulhoAty to Mdata any Oeovleionof any City
ordinance or Stat" law. rule nr tsgulatloo. Alf work thea be
it in 'sties eosaµLanea with all City ordinances. building
cod's and/or health dspatt+n'nt regulations. and shelf be
subitcl to inepectlon, approval ne relectlon by the City.
Whenever 8"
ordrd
ered, the undagned sgrees to comet
any .-k found to be N .solation of the conditions of
this permit.
Signa''ttu/u of Appficant�
Code White I do Copy Canary Innpec air's Copy
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteratio-i (Excavation
Grading, Filling, etc.)
Other:
After -the -fact Investigation
TOTAL
Slate Surcharge:
Total Amount Paid to City
Fee
S
Fee
S
Fee
S
Fee
S
Fee S
Fee S
Fee S�LJ
Fee S—IiQ-0
This permit is riot valid until the proper fee is paid and
it is approved by an authorized City Official.
•
Sig f City Official
Pink 1 inance Cop) Gold Applicant's Receipt