HomeMy WebLinkAbout1985-08-13 Permit, New Septic System #8039GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(6121473-7357
CITY PERMIT NO. 8039
Date fie _So
Owner. A111198 hk:� Z Address Gni 1t%1 �f �� ��_ 4 -.
Contractor D11 a.� e _ �; � '/ Address i/,A) l��r/ �G'Lt%%/
City License No. �D� f% �or _ __ __✓ State License No. >
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
Water Meter (Size—)
Meter/%
Remote
EW
Fee S
❑ ADDITION
Fee S _
Municipal Water Connection Fee S
❑Copper
Municipal Sewer Connection
❑ PVC ❑ Cast
MWCC SAC Charge
On Site Septic System
ACKNOWLEDGEMENT
Fee S _ - _
❑ REPAIR
Water Well
Mechanical Equipment
Moving !Lifting Buiidings
Land Alteration (Excavation,
Grading, Filli,,g, etc.)
Fire
Fee
S
Fro,
S
Fee
Ste_
Fee
S
Fee S
(—] Sprinkler System ( Fire) Fee S
Fee S. Other: Fee S
Fee S 7�'QC% After -the -fart Investigation Fee S
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all spatial information,
terms, conditions or requirements written above. The
undersigned under*[ -ads and agrees under penal'. 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 aporovaW and that this permit does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. Ali work shall be
done in strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subject to Inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agrees to correct
anv work found to be In violation of the conditions of
this permit.
Signof Applicant .
�z ► cn / l L
TO7 AL
State Surcharge:
Total Amount Paid to City
F ee S'
Fee S -7 G> 0c)
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Sign �- of City Offici
CRP �
Code White - File Copy Canary - Inspector's Copy hink- Finance Copy Gold -Applicant'; Receipt