HomeMy WebLinkAbout1983-08-03 Permit, Septic System Repair #7085GENERAL PERMIT
CITY OF ORONO
KCI -BOX 66
c RYSTAL BAY, MINNESOTA 55323
(61 2) 473-7357
CITY PI• RMIT NO. 7085
I1.Itt• -�
S1Dt
Contractor JAAddress
Address
City License No. ---- --
State License No.
RI MARES AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: ❑ NEW
Inside Plumbing ( # fixtures__, )
Wa ter Me ter (Size)
❑ ADDITION
Fee $
Fee S
Meter #
Remote #
Municlpal Hater C'unnectioll l:ee S
❑('Upper Q
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast
MWCC SAC Charge Fee S I
ACKNOWLEDGEMENT
The undersigned herrb>acknowledges receipt of this limited
Permit, including acceptance of all sDrclal Information,
terms, conditionsor requirements written above, The
undersigned understands and agrees under penalty of law
that this permit is strictly limited In scope to the work•
activitY or impreVement speclfled; that this permit does
not grant any authority to do work or acuvitles requiring
separate permit approvals; and that this permit does not
grant authorityto vyulate any Dructialun of any
ordinance or State laM, rule
dune in strict compliance w regulation. All work shall be
codeswith ail Oil ordinances, building
sub/eet and/or health department regulations• and shall be
M inspection, approval or re►ecuon by the C11s
Whenrcrr so ordered, the undersigned agrres to corrrcl
any work fond to be to %101"on of
this Permit. the cun•IiUun► of
Signatu of Applifan I
Code: White -1-1k Copy Canary-InVftitur's copy
XRFPAIR
On Site Septic: System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S
Fee
Fee --
Fee S
Fee S
Other:
Fee S
After -the -fart Investigabun Fee S
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S SU
Fee S 20 r°
This permit is nut valid until the proper fee is paid and
it is approved by all authorized City Official.
Sign re of ' ty Official
Pink- I inantx Copy Gold Applicant's Receipt