HomeMy WebLinkAbout1984-08-29 Permit, Septic System #7592f'
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GENERAL PERMIT
CITY OF ORONO
M
P.O.BOX 66
CRYSTAL BAY. MINNESOTA 55323
(612)473-7337
CITY PERMIT NO. 7592 I
!
Date
Owner /VIaA^
Contractor OiL^f
Address >
Address
City License No..State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE:
Inside Plumbing ( # fixtures.
Water Meter (Size 1
j^NEW □ ADDITION □ REPAIR
)Fee S.
Fee $.
Meter#,
Remote #
Municipal Water Connection
d Copper n__
Fee S.
Municipal Sewer Connection
□ PVC □ Cast Q
Fee S.
MWCC SAC Charge Fee S.
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee 5
Fee S______
Fee S______
Fee S______
Fee S______
cjO
Other:.
After-the-fact Investigation
Fee $
Fee S
ACKNOWLEDGEMENT
The undersigned hereby scknuwledget receipt of thU limited
permit, including gccepUnce of all special information,
terms, conditions or requirements written above. The
undersigned understands and agrees under penalty of law
that this permit is strictly Umited 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 SUte 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 condiUons of
this permit.
Sign,iJlfui^f Applicaiff^
c
TOTAL
Slate Surcharge:
Total Amount Paid to City
Fee S.SC»
Fee 5 "7^
This pemiit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
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Code: White I Uc Copy Canary ln%pcci(ir's Copy Pink • I'inancc Cepy Cold Applicant's Receipt