HomeMy WebLinkAbout1984-10-30 Permit, Septic SystemGENERAL PERMIT CITY PERMIT NO. ?688
CITY OF ORONO
P.O.BOX 66 Date L
CP.YSTAL BAY, MINNESOTA 55323
Z12)_473-7357 �/& ! /cOu%erAddress 57 mot- Q.S �/� z-C .J
Contractor ZAICI Address 366Ll 6
City License Nc. V State I icense No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
Wati-r Meter (Size—)
Meter#
Remote#
NEW ❑ ADP'ATION
Fee S —
Fee S
Municipal Water Connection Fee S
❑Copper
Municipal Sewer Connection
❑ PVC ❑ Cast n _
MWCC SAC Charge
On Site Septic System
ACKNOWLEDGEMENT
Fee S
Fee S
❑ REPAIR
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fire
Sprinkler System (Fire)
c-- Dther:
Fee S (After -the -fact Investigation
The undersigned hereby acknowledges receipt of this limited
Permit. including acceptance of all special information,
terms, conditions or repuirementa written above. The
undersigned understands and agrees under penalty of law
that this permit is strictly limited in scope to the work,
acuvity or improvement %Decitted; that this permit does
not grant any authority to do work or activities requiring
separate parmil approval; and that this p^rmi: does not
grant authority to violate any proWsion of any City
ordinance or State law, rule or regulation. Ali work shall be
done In strict compliance with all City ordinances, building
codes and+or health department-eguiations. and shall be
sub)ect to Inspection, approval or resection by the City.
Whenever so ordered, the undersigned agrees to comet
any work found to be in violation of the conditions of
this permit.
S' Appli a
Code.White- FileCopy Canary -Inspector's Copy
TuTAL
Fee S
Fee S
Fee $_
Fce S
Fee
S
Fee
S
Fee
S
Fee
S
State Surcharge: Fee S
Total Amount Paid to City Fee $ -0
ThiF permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signdilufe of City Official
�e
pink -Fin •nce Copy Gold -Applicant's Receipt