HomeMy WebLinkAbout1982-07-27 Permit, Septic System #6751CITY Pf RMIT NO.—�6'751
GENERAL PERMIT
CITY OF ORONO �-
P.O.BOX 66
Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner / �v`" �/'� _ Address
Alk-
Contractor A& Address
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE: AND FEE: ❑ NEW
Inside Plumbing ( # fiiixtures )
Water Meter (Size )
Meter # _
Remote #
0 ADDITION
Fee $
Fee $
Municipal Eater Connection Fee S
❑ Copper
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee $
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 agrees 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 permit approvals; and that this permit does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
codes and/or health 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.
Signature of
State License No.
�KRF.PAIR
On Site Septic System Fee S O OD
Water Well Fee S_
Mechanical Equipment Fee S
Moving/Lifting Buildings Fee S
Land Alteration (Excavation, Fee S
Grading, Filling, etc.)
Other: Fee S
After -the -fact Investigation Fee S
TOTAL
State Surcharge: Fee S '50
Total Amount Paid to City Fee S �0. 50
This permit is not valid until the proper fee is paid and
it i; approved by an authorized City Official.
Sign- r of City Otfial %
��m
Code. White I ile Copy Canary In,pector's Copy Pink I inane. Cup} Gold Applicant's Receipt