HomeMy WebLinkAbout1984-11-15 Permit, Septic System #7717GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY. MINNESOTA 55323
(6 12) 473-7357
Owner 'SO_At- k- e- ✓ l�.t. Dam .
Contractor Jit tT n in 4 e
City License No. :�:200 q
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_ )
❑ NEW ❑ ADDITION
Fee S __
Water Meter (Size—) Fee S
Meter # _
Remote #
Municipal Water Connection Fee S____
❑Copper
Municipal Sewer Connection Fee
❑ PVC ❑ Cast r-
MWCC SAC Charge Fee S .
On Site Septic System
ACKNOWLEDGEMENT
CITY PERMIT NO. 7717.
Date //— /r'— !?!K -
Address
Address _�3 do o o MAJIF 1
/
State License No.
❑ REPAIR
Water Well
Fee S
Mechanical Equipment
Fee $
Moving /Lifting Buildings
Fee $
Land Alteration (Excavation,
Fee $
Grading. Filling, etc.)
Fire Fee S
Sprinkler System (Fire) Fee S
ther: Fee S
Fee S -7 S, 0 OlAfter-the-fart Investigation Fee S
The undersigned hereby acknowledges receipt of this Welted
permit, including acceptance of all 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.
activity or improvement specified: that this permit does
not grant any authority to do work or activities requiring
separate permit approvals; and that this permit does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. Ali work sball be
done in strict compliance with all City ordinances, t•ailding
codes and/or health departmert regulations, and shall be
sublect to inspection, approval or resection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
S' of Appli01
,
TOTAL
State Surcharge:
Fee $ _e !:;Y)
Total Amount Paid to City Fee S
This pennit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
Code: White I He Copy Canary Inspector's Copy Pink—Finance Copy Gold- Applicant's Receipt