HomeMy WebLinkAbout1986-06-16 Permit, Septic System #8522GENERAL PERMIT CITY PERMIT NO. 8522,
CITY OF ORONO l� __C
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P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357 7- /
Owner �� O Address5
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Contractor �1� I Address—'Er2vT f k D
City License No. 's f t i AC4- State License No.
REMARKS AND SPECIAL CONDITIONS
— 7 �D — 7 mil) w�l7r ��rti•.� � �Ce�-t.
PERMIT TYPE AND FEE
Inside Plumbing ($fixtures._)
Water Meter (Size—)
Meter #
Remote 4
NEW ❑ ADDITION
Fee S
Fee S
Municipal Water Connection Fee S
❑Copper Q
Municipal Sewer Connection Fee S _
❑ PVC ❑ Cast El
MWCC SAC Charge Fee
On Site Septic System Fee S
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limita,l
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 don
not grant any authority to do work or activities requiring
separate permit approvals: and that this permit does not
Rant authority to violate any provision of any City
ordinance or State law, rule or regulation. AU work shall be
done In strict compliance with all City ordinances, building
codes and/or health department regulations• and shell be
abject to Inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be In violation of the conditions of
this permit.
Signal re of Applicant
❑ REPAIR
Water Well
Fee S
Mechanical Equipment
Fee S
Moving /Lifting Buildings
Fee S
Land Alteration (Excavation,
Fee S
Grading, Filling, etc.)
ire Fee S
)rinkler System (Fire)
ther:
fter-the-fact Investigation
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee S
Fee S
Fee S ,SCo
Fee _�a e�n
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signapre of City official
Code- While - File Copy Canary u.spector's Copy Pink —Finance Copy Gold —Applicant's Receipt