HomeMy WebLinkAbout1983-07-28 Permit, Septic System #7076GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner 111"e'L'
i An , /W
Contractor
City License No.
RLMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: kNEW ❑ ADDITION
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter # _
Remote #
Fee S
Fee S
Municipal Water Connection Fee S
❑Copper Q
Municipal Sewer Connection Fee S_
❑ PVC ❑ Cast n
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee S
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions or requirements written above. The
undersigned understands and &woes 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 Perinit approvals; and that this permit does not
Brant authority to violate any provision of any City
ordinance
inace or State law, rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
. odes and/or health department regulations, and shell be
abject to inspection, approval or resection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signature of Ap licant/
CITY PERMIT NO. 7076,
JDate t
75� AddressAl-
Address,(
CV `
State License No.
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:
After -the -fart Investigation
TOTAL
Fee SAS �0
Fee
S
Fee
S
r;e
S
Fee
S
Fee
1
S
Fee
S I
State Surcharge: Fee S �ell
Totai Ani uunt Paid to City Fee S —J _S6
This permit is not valid intil the proper fee is pu:.: and
it is approved by an aut,..,rized City Official.
Sign• i of City Oftici'
JNXV
S
Code: White -Pile Copy Canary Inspector's Copy Pink I inance Copy Gold Applicant's Receipt