HomeMy WebLinkAbout1983-07-29 Permit, New Septic System #7079GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(61 2) 473-7357
CITY PERMIT NO. 7079 1
Date 7 — 2-0' — S
Owner- C' rT 2VAe!X1QtJ Adtlres 2y� Cowtm-Ville UR
Contractur 7�)iw.4fIF r—IRT�EAC Address —7/?� VNeAoNF IT , C'�F'l'12
City License No.
REMARKS AND SPHCIAL CONDITIONS
State License No
v�rfl S ys-g - ) o x 6, 3 _
,eC-1i1jp4j�) -!5gAC LntA.) 'TXaj'4'j COV -S
PERMIT TYPE AND FEE: X NEW ❑ ADDITION
Inside Plumbing ( # fixtures ) Fee S
Water Meter (Size ) Fee S
Meter #
Remotc #
Municipal Water Connection Fee S
❑Copper
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast n
MWCC SAC Charge
AC'KNOWL EDGEMENT
Fee S
The undersigned hereby acknowledges receipt of this limited
Vermit, including acceptance of all special information,
terms, conditions or requirements %diten al�,rvs. The
undernaned understands and agrees under penalty of law
that utas permit Is strictly limited in scope to the work,
activity or improvement specified: that this permit does
not grant any authority to Jl� werk or activities requiring
$Operate permit approvals. and rnat this permit does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. Aa work shall be
done in strict compliance with as City ordinances, building
codes and/or health department regula ijns, and &hall be
subktct to inspection, approval or rekction by the City.
Whenever so ordered, the undersigned agrees to correct
anywork found to be in violation of the conditions of
this permit.
Signof Applicant
, tit23ZI'L4
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Fee S
Fee S
Moving/Lifting Buildings Fee S
Land Alteration (Excavation, Fee S
Grading, Filling, etc.)
"Cerj.S c o0
Other: Fee S 1-a�—
After-the-fact Investigation Fee S
TOTAL
Stats: Surcharge: FCC S 60
SD
Total Amount Paid to City Fee S 6—n
This pennit is not valid until the proper fee k paid and
it is approved by an authorized City Official.
Signature of City Official
r
Code: White- file Copy Canary Inspector's Copy Pink I inancc Copy Gold Applicant's Receipt