HomeMy WebLinkAbout1984-04-23 Permit, Septic System #7385GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
CITY PERMIT NO. 7385 •
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Owner TvwtoO Address
Contractor ST7^ct^ ne>v C,-
City License No._______________________________
Address /V/^O ^
PCTZTTCT
State License No.
REMARKS AND SPECIAL CONDITIONS
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PERMIT TYPE AND FEE:
Inside Plumbing ( # llxtures.
Water Meter (Size____)
Meter #____________
NEW □ ADDITION
) Fee S________
Fee S________
Remote §
Municipal Water Connection Fee S.
□cbpper n
Municipal Sewer C onnection
□ PVC □ Cast Q
Fee S.
MWee SAC Charge Fee S.
□ repair
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S 7^
Fee S_
Fee S_
Fee S —
Fee S_
Other:.
After-the-fact Investigation
Fee S ^ ^
Fee S__
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ACKNOWLEDGEMENT
The undersienrd hereby ecknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions or requirements written above. The
undersigned understands and agrees under penalty of law
that this permit is strictly limited in scope to the work,
activity nr 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
subiect 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.
SifiimiHun* of Applicant
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V
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S,
ii
Fee S loo --
This penult is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official ^
Code. WTiitc I lie Copy Canary Inspector’s Copy Pink-1 inance Copy Cold Applicant's Receipt