HomeMy WebLinkAbout1983-7200 - trench drainfield w/pump system GENERAL PERMIT CITYPERMITNO. _—�200 �
CITY OF ORONO
P.O.BOX 66 Date �G — /�-- ��
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
.
Owner ���d?�� Address ��.� �i��uu�/1v� �� � .
Contractor Address �
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
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PERMIT TYPF. AND FEE: ❑ NEW ❑ ADDITION �REPAIR
lnside Plumbing � # fixtures ) Fee $ On Site Septic System Fee $��`�
Water Meter(Size ) Fee $ Water Well Fee $
Meter #
Mechanical Equipment Fee $
Remote#
Mlxnicipal Water Connection Fee $ Moving/Lifting Buildings Fee $
❑Copper ❑ Land Alteration (Excavation, Fee $
Grading, Filling, etc.)
Mtinicipal Sewer Connection Fee $
❑ PVC ❑ Cast n Other: Fee $
M'vVCC SAC Charge Fee $ After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of ell special information,
terms, conditions or requirements written above. The State Surcharge: Fee $ "� b
undersigned understands and a�ees 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 Total Amount Paid to City Fee $ � r d' 0
sepazate permit approvals; and that this permit does not
�ant 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 depaztment regulations, and shall be This permit is not valid Uritll t110 prOpel' fee is paid and
sub]ect to inspecUon, approval or relection by the c�tv. it is approved by an authorized City Official.
Whenever so ordered, Lhe undersigned agrees to correct
any work found to be in violation of the conditions of
this perxnit.
Signature A p i nt Signature of City Official
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Code:White—File Copy Canazy—Inspectur's Copy Pink—t'inance Copy Gold—Applicant's Receipt