HomeMy WebLinkAbout1984-03-13 Permit, Septic System #7346GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CR i _.: AL BAY, MINNESOTA 5 5323
(612) 473-7357
Owner 8ki: rZ
Contractor — iCpaq J e.'
City License No.
REMARKS AND SPECIAL CONDl fIONS
CITY PERMIT NO. 7346,
Date 1174re-GH / .:3 IVRV
V
Address
Address
PERMIT TYPE AND FEE: XNEW ❑ ADDITION
Inside Plumbing ( Al fixtures ) Fee S
Water Meter (Size ) Fee S
Meter #
Remote M
Municipal Water Connection Fee S
❑ Copper a —
Municipal Sev, r Connectir
❑ PVC ❑ Cast _
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee S
State License No
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
f Grading, Filling, etc.)
I Other:_
Fee $ ! After -the -fact Investigation
The undersigned hereby acknowledges receipt of this limited
psrmit, including acceptance of W special informstlon,
terms, conditions or requirements written above. The
undersigned understands and &grave under penalty of law
that this permit is strictly Umlted 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 low, rule or regulation. AU 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 underslgnvd agrees to correct
any work found to be in violation of the conditions of
this permit.
Signa of Applicant
Code: White -File Copy Canary Inspector's Copy
TOTAL
Fee S 3 ,�—a+=C
Fee
S
Fee
$
Fee
S
Fee
S
Fee
S
Fee
S
State Surcharge: Fee S SV
Total Amount Paid to City Fee S 3�
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Siiggnature(of City Oftu gal
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Pink Finance Copy Gold -Applicant's Receipt