HomeMy WebLinkAbout1984-11-14 Permit, Septic System #7715GENERAL PERMIT CITY PERMIT NO. 7715
CITY OF ORONO
P.O.EOX 66 Date _
CRYSTAL BAY, MINNESOTA 55323
� (612) 473-7357 /
Owner /C�/'-4"'D'% ��'SE n'�-ti1F Address 2 `� >rrerryc,/4
Contractor -\ L-tAddress A4pt,/Ay4
City License No.
REMARKS AND SPECIAL CONDITIONS
`7:�? __ / s. , t S ,/n.
State License No.
PERMIT TYPE AND FEE: * NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing (Mixtures_) Fee S
Water Meter (Size—)
Meter#
Remote
Fee — -
ater Well
- (Mechanical Equipment
Municipal Water Connectiot, Fee S
❑Copper 0
Municipal Sewer ( onnection Fee S
❑ PVC ❑ Cast Q
MWCC SAC Charge Fee S _
On Site Septic System Fee S
ACKNOWLEDGEMENT
The undersigned hereby acanowledtles receipt of this limited
permit, including acceptance of all special information,
terms, conditions or tvquirementa written above. The
indersianed 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 �provals: and that this permit does not
grant authority to violate any provision of any City
ordi:.anc. or State law, rule or reguladcn. Ali work shall be
Aire in stric, compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subiect to lnrnectlon, approval or relection by the City.
Whenever so ordered. the undersigned agrees to correct
anv work :n;:nd to be in violation of the conditions of
: is pennit.
Signature Applicant 1
.cam i' I
/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee
S
Fee
S _
Fee
S _
Fee
S
Fire Fee S _
Sprinkler System ( Fire) Fee S _
her:
fter-the-fact Investigation
TOTAL
Fee S _
Fee S _
State Surcharge: Fee S JT-)
Total Amount Paid to City Fee S 7 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 j
Code: White file Copy Canary Inspector's Copy
Pink -I inancc Copy Gold Applicant's Receipt