HomeMy WebLinkAbout1984-07-16 Permit, Septic System #7508GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
1612 473 7357
CITY PERMIT NO. 7508 1
Date 7-/6 g�Z
A.
Owner iW�t-U S COAIS.Address __ Z Zws pL /",y
ContractorQrT71/dno� �P_oS Address �� Z e_4R Gr bIt.` -',�--
City License No
REMARKS AND SPECIAL CONDITIONS
State License No.
pfou&?I�N SY SrZE-ZK Pew -ye,
1D,ftV X> S - 3 - Py
PERMIT TYPE AND FEE: XNEW
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter #
Remote N
❑ ADDITION
Fee S
Fee S
Municipal Water Connection Fee S
❑Copper n
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast n
MINCC SAC Charge Fee S
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
Permit. including acceptance of all special Information,
terms, conditions of 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
sepamte permit approvals; and that this permit does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. All 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 to ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signature of Applicant �J
❑ REPAIR
On Site Septic System Fee S
Water Well Fee S
Mechanical Equipment Fee S
Moving/Lifting Buildings Fee S
Land Alteration (Excavation, Fee S
Grading, Filling, etc.)
Other: SC-PnC— L--IC-ts*S (:F Fee S Z1�
After -the -fact Investigation Fee S
TOTAL
State Surcharge: Fee S S�
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Total Amount Paid to City Fee S4)ro
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signat_UM of City Official
Code White I ilc (up) Canary Inspet t,-r's Copv Pink F inance Cop) Gold Applicant's Receipt