HomeMy WebLinkAbout1984-07-11 Permit, Septic System #7500GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
CITY PI RMITNO.7500'
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Owner —..j~ ... --------- Address _ ^^0 _____
_£)u<^k^ /V /5y ^
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Contractor
City License No.
REMARKS AND SPECIAL CONDITIONS
State License No.
/'^OD
6TD ^i4K^ ^y/fA yhi^in^ '
PERMIT TYPE AND FI I ;
Inside Pliinibing( M fixtures
Water Meter (Si/e____)
Fee $,
Fee S,
Meter .#
Remote #
Municipal Water Connection
n Copper l~l
Fee $,
Municipal Sewer Connection
□ PVC □ Cast Q
Fee S.
MWee SAC Charge-Fee S.
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:.
Fee S
Fee S
E'ec S
Fee S
Fee S
Fee S.
After-the-fact Investigation Fee S
ACKNOWLEDGFMFNT
The undrraitfi€<1 hereby arknowledfet receipt of thU ttmlted
permit, including erceptanre of tU Inforniettoii,
termt. (t>nditton» or requirements written sbnve. The
underngned understands and agrees under penaltv ol law
that this permit is strictly bmiced in scope to the work,
activity or improvement specified: that this permit does
not grant any authority to do work or aettvidet requiring
aeparau permit approvals, and that this permit does not
grant authority to violate any provision of any City
urdiuance or SUte law. rule or regulaUon. All work shall be
done in strict comptience with all City ordinances, budding
codes and/of health department regulations, and shall bt
fublect to inspectioA, approval or reiecdon by the City.
Whenever so ordered, the undersigned agrees to correct
any work ^ound to be in violedon of the conditions of
this pemUL
TOTAL
Sldtc Surcharge:
Total Amount Paid to City
Fee S
Pec S
Signature oftAfpl^
C\>de White f gi? (C'aiUjy Ua *i Cop>
This permit is not valid until the projH-r fee is paid and
it is approved hy an authon/cd City UHicial.
Signj)4l^ of City OlTici
Fifiii I tnence Copy <*tdd ApplKant « Receipt