HomeMy WebLinkAbout1984-10-16 Permit, Septic System #7663GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 7663
Date /0.16-,eLl
Owner e'�;A-V_j (fdN N e-1- l.` Address _ gU,7D &Ief /.D /2,•'YI-p
Contractor 1���/�E N4+�/T Address _ /144*LE- 134- IA J
Cite License No.
RLMARKS AND SPECIAL CONDITIONS
State License No.
Irm) cry1 s KC "4 �V ivy -!-V-S TF- Vk
PERMIT TYPE AND FEE: %NEW
II1tiILIC Plumbing ("fixtures_) Fee S
Water Meter (Size_) Fee S
Meter#
Remote Al
Municipal Water Connection Fee S
❑ ( upper n
❑ ADDITION ❑ REPAIR
Municipal Sewer Connection Fee S .
❑ PVC ❑ Cast n
MWCC SAC Charge
On Site Septic System
ACKNOWLEDGEMENT
Fee S .
Fee C 7 S
The undersigned hereby acknoaledges receipt of this limited
Permit. including acceptance of all special information,
temu, conditions or requirements written above. The
updersianed 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 does
not grant any authority to do work or activities requiring
separates permit approvals; and that this permit does not
grant authority to violate any provialon of any Clty
ordinance or State law, rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
sublect to Inspection, approval or reJection by the Citv.
Whenever so ordered, the undersigned agrees to correct
any work found to be io violation of the conditions of
this permit.
S1, the of Applicant
iter Well
-- IMechani,al Equipment
oving /Lifting Buildings
Land Alteration (Excavation,
Grading. Filling, etc.)
ire
System (Fire)
Fee
S
Fee
S
Fee
S
Fee
S
Fee S
Fee S
[her: Fee S
fter-the-fact Investigation Fee S
TOTAL
S�
State Surcharge: Fee S
SV
Total Amount Paid to City Fee S _
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
Code While I ile Copy Canai) Inspector's Copy Pink—I inance Copy Gold Applicant's Receipt