HomeMy WebLinkAbout1982-11-16 Septic System #6878GENERAL PERMIT CITY PERMIT NO.--6878I
CITY OF ORONO
P.O.BOX 66 Date _
CRYSTAL_ BAY, MINNESOTA 55323
(612) 473-7357
I
Owner G . Address S % z� • !
Contractor W'11� _d - Address �
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
,�_l1 U t
PERMIT TYPE AND FEE
Inside Plumbing ( # fixtures
Water Meter (Size )
Meter #
Remote #
❑ NEW UADDITION
Fee $
Fee $
Municipal Water Connection Fee $
❑ Copper ❑
Municipal Sewer Connection Fee11 $
❑ PVC ❑ Cast ❑
MWCC SAC Charge
ACKNOWLEDGEMENT
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:
Fee $ i After -the -fact Investigation
'he undersigned hereby acknowledges receipt of this limited
Lrrmit, including acceptance of all special information,
terms, conditions 3r 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
@operate permit approvals; and that this permit does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. Ali 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 ba• in violation of the conditions of
this permit.
Signatu • of Applicant
TOTAL
State Surcharge:
Total Amount Paid to City
Fee
$ 210 - 06
Fee
$
Fee
$
Fee
$
Fee
$
Fee
$
Fee
$
Fee $
Fee $ABC
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
Code: White File Copy Canary Inspector's Copv Pink- Finance Copy Gold Applicant's Receipt