HomeMy WebLinkAbout1982-09-16 Permit, Septic System #6808CITY Pt:RMIT NO. --6g0$
GENERAL PERMIT
CITY OF ORONO
Date
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
j (612) 473-7357
Owner Address
I
Contractor �A%�w C ��ti �✓A Address sL
City License No,
REMARKS Ai ID SPECIAL CONDITIONS
PERMIT TYPE AND FETE: pd NEW ❑ ADDITION
Inside Plumbing ( # fixtures ) Fee $
Water Meter (Size )
Meter #
Remote #
Fee $
Municipal Water Connection Fee S
[]Copper
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast
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 agrees under penalty 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 permit does not
grant authority to violate any 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 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.
Signatu Volpplicant
State License No
❑ REPAIR
On Site Septic System Fee $ 3 5,1)
Water Well Fee $
Mechanical Equipment Fee $
Moving/Lifting Buildings Fee $
Land Alteration (Excavation, Fee $
Grading, Filling, etc.)
Other: — Fee $
After -the -fact Investigation Fee S
TOTAL
State Surcharge:
Fee
$
'So
Total Amount Paid to City
Fee
$
35, SU
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
fin. \ - I 'a - M
Code: White File Copy Canary —Inspector's Copy Pink -Finance Copy Geld Applicant'% Receipt