HomeMy WebLinkAbout1983-06-24 Permit, Septic System #7041GENERAL PERMIT
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CITY PERMIT NO. --70411
CITY OF ORONO-2y-83
Bate
P.O BOX 66
CRYSTAL BAY, MINNESOI A 55323
(U-12) 473-7357
Owner , - f��IVST.
Address
Contractor � t �� ._ _
Address %Ii-Y.4_ _AVIV> - /WMV_9 i -.-_
City License No. - — -------_-_._—
State License No. —_----_---_
REMARKS AND SPECIAL CONDITIONS
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its,
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PERMIT TYPE A.Nu ri:E: XNFW ❑ AUDITION ❑ REPAIR
Inside Plumbing( M fixtures_,_) Fee S
On Site Septic System Fre y�.1� _
Water Meh.r (Size ) !-ee S
Water Well Fee
Meter #---_-_--- --- .—
Mechanical Equipment Fir S --
Remote
Municipal Water Connrttic.. Fir S
Moving/Lifting Buildings Fee S _
UCepper Q._— —____
L;�-td Alteration (Excavation, Fee S- —____
Grading, Filling, etc.)
Municipal Sewer C'onnccrion Fee 3
_
❑ Pvc [j (atit Q __-.- . —
Other: Fee S --
MWCC SAC Charge Fee S
After-tite-f-act Investigation Fee S
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions or requirtmenu written abo•e. 1t.
undersigned understands and apeea under penalty of Is -
that this permit Is stricuy limited in scope to is work,
activity or improvement .pecirledi that this to .nit does
not pant any authority to do work or acUcitie, requiring
separate permit approvals, and that this permit does not
Quit authority to viulste io-Y provision of any City
ordinaaee or State law, rule or regulation. Ali work shall be
dune in strict compliance wi•.h all Cit) urdl,.ancea, budding
codes andf.o health department regulnuons, and @ball be
sublecI to inspection, approval .w relecuo.: by the City.
neve- t Wha(i ordered. the undersigned agrees to correct
any wot,t found to be in .lulati..n of the condli.�ns of
We pern.it.
Signature ul' Ap, licant
TO I -AL
State Surcharge Fee S
Total Amount Paid to City Fee S 3
'This pennit is not %slid until the proper fee is paid and
it is approved by an authorized City Official.
Signature ofCity Official
(.oar Wkite t ile Copy — -- Canar) ln>ractol'! ('op)
Pink 1 inance Cop) Gott! iipplicalnt'<. Receipt