HomeMy WebLinkAbout1983-06-24 Permit, Septic System #7042GENERAL PERMIT CITY PERMITNO._-704$1
CITY OF ORONO G-2y-lg
f .O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-773�57
Owner S�L/'��'�_D ( "'Vs '. Address 3 7 7d C—Aly -
Contractor DN / er Address ME*A AV—� m k
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE. AND FEE: XNEW
lnside Plumbing ( Al fixtures )
Water Meter (Size—)
Meter
Remote N
❑ ADDITION
Fee S
Fee S
Municipal Water Connection Fee S
❑Copper
Municipal Sewer Connection Fee S
❑ PVC' ❑ Cast ❑
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee S
The undersigned hereby acknowledges receipt of this limited
permit. Incluutng acceptance of all special Information,
terms. conditions or iequiremenU written above. The
undersigned understands and agrees under penally 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 activi:les requiring
separate permit approvals: and that this permit does not
grant authority to violate any provision of any City
ordinance or State law, r 'e w regulatlon. Ali work shall be
done In strict compliance with ail City ordinances, building
codes and/or health department regulations, and shall be.
subject to Inspection, approval or r0ectlon bs the City.
Whenever sc ..rdered, the undersigned agrees to correct
any work found to be in violation or the conditions of
thla permit.
Signature of Applicant
State Licenu No.
❑ 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, OV, )
Other: Fee S
After -the -fact Investigation Fee S
TOTA
State Surcharge: Fee S CID
Total Amount Paid to City Fe. S
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Sign at of City Offic I
C It, white—l-ot Copy Canary Inspecti-r's Copy Pink I inance Cop) Gold Applicant's Receipt