HomeMy WebLinkAbout1983-07-06 Permit, Septic System #7138GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(6' -) 473-7357
CITY PERMIT NO. 7138
Date 7- 6 -�
Owner
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Address
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Contractor LAJ
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Address
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City License No,
State License No.
REMARKS AND SPECIAL CONDITIONS
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PERMIT TYPE AND FEE: X NEW ❑ ADDITION
ln,.ide Plumbing ( # fixtures ) Fee S
Water Meter (Size_,)
Meter #
Remote #
Fee S
Municipal Water Connection Fee S
❑Copper Q
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast
MWCC SAC Charge
AC'KN04LEDGEM ENT
Fee $
The unnersigned 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 grunt any authority to du 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 &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
.ny work found to be in violation of the condltions of
his permit.
Signatu of Applicant /
❑ REPAIR
00
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, etc.)
Other: Fee S
After -the -fact Investigation Fee S
TOTAL
State Surcharge:
Fee
S
- D
Total Amount Paid to City
Fee
S
3 S Sn
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signatur ity Ofticia
Code. White - File Copy Canary - inspector's Copy Pink I inance Copy Gold Applicant's Receipt