HomeMy WebLinkAbout1984-10-30 Permit, Septic System #7684GENERAZ PERMIT CITY PERMIT NO. 7685
CITY OF ORONO Date /G-�G-
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
�e 7�7 Address L C
Owner
Contractor Address rZI,
VU
City License No. _ State License No. a 9 y
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
Water Meter (Site _ )
Meter#
Remote #
❑ NEW ❑ ADDITION
Fee S
Fee S
Municipal Water Connection Fee S
❑Copper In
Municipal Sewer Connection
❑ PVC ❑ Cast
MWCC SAC Charge
On Site Septic System
ACKNOWLEDGEMENT
Fee S
n
Fee S
Fee S `/!!140
The undersigned hereby acknowledges receipt of"limited
permit. Including acceptance of all special Information.
terms, conditions or requirements wdtten above. The
undersigned understands and agrees under penalty of law
that thle permit Is strietiy limited to scope to the work.
activity or improvement specified. that this permit does
not grant any suthodtar 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 law, rule or regulation. Ali work sball be
done in strict compliance with all City ordinances. building
codes and/or bealth department regulations. and shall be
subject 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.
Sattire of 'cant ,
i
❑ REPAIR
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
!r System (Fire)
e-fact Investigation
TOTAL
State Surcharge:
Fee S
Fee $
Fee S--j
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
Total Amount Paid to City Fee S_1-!5f 5n
I
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
SignaturF of City Official \
Code White -file Copy Canary -Inspector's Copy Pink -Finance Copy v Gold -Applicant's Receipt