HomeMy WebLinkAbout1983-08-30 Permit, New Septic System #7128CITY PERMIT NO.—'71,`�g
GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66 Date _
CRYSTAL BAY, MINNESOTA 55323
161 _1473-7357
Owner �• �Address �d-�_ '
Contractor l/ ^ 6I)S. Address
4
City License No
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE ` D FEE
Inside Plumbing ( # fixtures
Water Meter (Size )
Meter # _
Remote #
NEW ❑ ADDITION
)\ Fee S
Fee S
Municipal Water Connection Fee $
❑ Copper
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast ❑
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee $
The undersigned hereby ackno%ciedges receipt of this limited
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 apes not
grant authority to %iolate any provision of any City
ordinance or State law, rule or regulation. All work shsll be
done In strict compliance with all City ordinances, building
rudes and/or health department regulations, and shall be
subject to inspection, approval or rejection by the City.
s Whenever o ordered. the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signature f Applicant
State License No.
❑ RUPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:
After-ttie-fact Investigation
TOI.`.L
State Surcharge:
Total Amount Paid to City
Fee S
Fee
$
Fee
$
Fc' ,
$
Fee
$
Fee
$ _
Fee
S _
Fee $
Fee $ sell JLl
This permit is not valid until the proper tee is paid and
it is approved by an authorized City Official.
Sig t e of City Official
.Z/bS s
Cale- White. -File ('nnv Canary-Insnector's Coov Pink - finance Copy Gold Applicant's Receipt