HomeMy WebLinkAbout1982-05-27 Permit, Septic System #6695GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 66951
Date 5-- o? ` O
Owner66�Address � �•
Contractor ���,�� Address
City License No,
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FLE: XNEW
Inside Plumbing (# fixtures )
Water Meter (Size )
Meter # _
Remote #
❑ ADDITION
Fee 5
Fee S
Municipal Water Connection Fee S
❑Copper
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast CL---
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee S
The undersigned hereby acknowledges receipt of this limited
permit. Including acceptance of ad special information,
terms, conditions or requirements written above. The
undersigned understands and agrees under penalty of law
that this permit is strictly limited In scope to the work,
— 'vityor Improvement specified. that this permit does
not 4'nt any authority to do work or activities requiring
"para to r'Rnit approvals; and that this permit does not
grant author.'v 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, budding
codes and/or health department regulations, and shall be
subject to inspection, approval of rejection by the City.
Whenever to ordered, the undersigned agrees to correct
an) work found to be to violation of the conditions of
this permit.
Sign urr f Applir t
State License No.
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
/ X
Fee S 1;
Fee
S
Fee
S
Fee
S
Fee
S
Other: Fee S
After -the -fact Investigation Fee S
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee S S
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature: of C' y O f- 'i
Code; White ile Copy Canary Inspector's Cop► Pink A inance Copy Gold Applicint's Receipt