HomeMy WebLinkAbout1982-01-11 Permit, Septic System #6611GENERAL PERMIT
CITY OF ORONO
CITY PERMIT NO. 6611
P.O.BOX 66
Date /—/l—,P
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner/�)ehAddress �L� G ��%��D U A&
Contractor / Address
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: X NEW
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter #
Remote #
❑ ADDITION
Fie $
Fee $
Municipal Water Connection Fee $ _
❑ Copper
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast Q
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 apees 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 perms: does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. All work &hall 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 Applicant
State Licen,�� No.
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee
$
Fee
$
Fee
$
Fee
$
Fee
$
Other: Fee $
After -the -fact Investigation Fee $
TOTAL
State Surcharge: Fee $ •Sn
Total Amount Paid to City Fee $
This permit is net Valid anti! the proper fee is paid and
it is approved by an authorized City Official.
Signa ure of City Official
Xky21_31 1-1
Code. White -File Copy Canary Inspector's Copy Pink- Finance Copy Gold Applicant's Receipt