HomeMy WebLinkAbout1986-06-16 Permit, Septic System #8523GENERAL PERMI1CITY PERMIT NO. 8523,
CITY OF ORONO
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner 1I C C' �C Address 14'A 1 i�
Contractor NCB '_.`f ' t IT1 I Address
City License No.L)'O'l-1 CJ 11` cl State License No.
REMARKS
AND SPECIAL CONDITIONS
)-) 0 / --
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
Water Meter (Size—)
Meter #
Remote #
NEW ❑ ADDITION ❑ REPAIR
Fee S Water Well
Fee S __--_ Mechanical Equipment
Municipal Water Connection Fee S —_.—
❑Copper n
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast n
MWCC SAC Charge Fee S
On Site Septic: System Fee S
ing /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fire
Sprinkler System (Fire)
Fee
S
Fee
S
Fee
S
Fee
S
Fee S
Fee S
ther: Fee S
fter-the-fact Investigation Fee S
ACKNOWLEDGEMENT I TOTAL
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions or requirements written above. The
n4ersigned understands and agrees under penalty of law
this permit Is stricU• limit*d in scope to We w'Ak,
IV or improvement specified: that this permit does
not grant any authority to do week or activities re40, r vS
separate permit arprovals: and that this permit doe .-A
pant authority to violate any provision of any ,..ttr
ordinance or State law, rule or •psulation. All work shall be
d-ne in strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subject to inspection, aprroval 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.
Signatur • of Applicant
State Surcharge: Fee S
Total Amount Paid to City Fee S ?
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature,of City Official,
71
Code White -File Copy
Canary Inspector's Copy Pink I inance Copy C II —Applicant's ReMpt