HomeMy WebLinkAbout1985-11-19 Permit, Septic System #8196t
GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 8196
Date l r i 1 0 15
Owner S Address
Contractor dress
City License No. - 1 ate License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing (#fixtures_)
Fee S
Water Meter (Size—)
Fee S
Meter#
Remote #
Municipal Water Connection
Fee S
❑Copper n
Municipal Sewer Connection
Fee S
❑ PVC ❑ Cast n
MWCC SAC Charge
Fee S
On Site Septic System
ACKNOWLEDGEMENT
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Ire
kler System (Fire)
ther:
•-7� r-' U
Fee SI. After -the -fact Investigation
The undersigned hereby acknowledges r. •ipt of this limited
permit, including acceptance of all special Information,
terms, conditions or requirement& 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
separate permit approvals. and that this permit does not
Omni authority to violate any provision of any City
ordinance or State taw, 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
sublect to UmMeetion, approval or rekction by the City.
Whenever a0 ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signature of Applicant
TOTAL
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
State Surcharge: Fee $
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 Offfc/i
Code: White -File Copy Canary -Inspector's Copy Pink -Finance Copy Goid-Applicant's Receipt