HomeMy WebLinkAbout1982-09-01 Permit, Septic System #6789GENERAL PERMIT CITY PERMIT NO.76789
CITY OF ORONO
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 553
(612) 473-7357 �/• 5,�
Owner Address A9 �V %
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Contractor &ager Address
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: NEW
Inside Plumbing ( # fixtures ))
Water Meter (Size )
Meter $
Remote #
❑ ADDITION
Fee S
Fee S
Municipal Water Connection Fee S
❑Copper
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast r7l
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee S
The undersigned hereby acknowledges receipt of this limited
permit. Including acceptance of an special Information.
terms. conditions or requirements written above. The
undersigned understands and agrees under psna&ty of law
that thts permit is strictly limited In scope to the work.
activity or Improvement spadfled; that this permit does
not grant any authority to do work or activities requiring
separate permit approvals; and that thts permit does not
grant authority to violate my 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 regulation &. and shall be
subleet to Inspection, soproval or refection by the City.
Whenever so ordered, the undersigned ogees to correct
any work found to be in violation of the conditions of
this permit.
Signature f Applic nt
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:
After -the -fact Investigation
TOTAL
Fee S
25700
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
State Surcharge: Fee S o
Total Amount Paid to City Fee S_.�1T
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Sig a of Of
Code: White - File Copy Canary -Inspector's Copy Pink -Finance Copy Gold --Applicant's Receipt