HomeMy WebLinkAbout1984-11-08 Permit, Septic System Repair #7702GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
CITY PERMIT NO. 7702
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Owner CZA tC^L __
Contractor /a] ir>/yiencL. .
Address ^ ^
A.-jda*ss —Af_____________
City License No.State License No.
REMARKS AND SPECIAL CONDITIONS
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7:ST>—laX__T>£t^i/AJ _____________
PERMIT TYPE AND FEE:
Inside Plumbing (Affixtures__)
Water Meter (Si/e__)
Meter# ______________
□ NEW □ ADDITION ^K(r EPAIR
Fee S
Fee S
Remote #
Municipal Water Connection
n Cop pe r r~i
Fee S_
Municipal .Sevvci Connection
□ PVC □ Cast Q
MWee SAC Charge
On Site Septic System
Fee S-
Fee $-
Fee S
cre>
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation.
Grading. Filling, etc.)
Fire___________________
Sprinkler System (Fire)
Other:_____________
After-the-fact Investigation
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
ACKNOWLEDGEMENT
The undersigned hereby acknowledgei receipt of this limited
permit, including sccepUnce of ell 9«cial information*
terms, conditlnns or requirements written above. The
undersigned understands and agrees under penalty of law
that this permit is strictly limited in scope to the work,
actisity or improvement specified; that this permit does
not grant any authority to do work or actisities requiring
separate permit approvals: and that this permit does not
grant authority to vic»late 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 reiecdon by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signamre of Applicapt / /
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee $
so
This pennit is not valid until the proper fee is paid and
it is approved by an authorized City Official,
Signature of City Official
Pi
Code. While - I ik Copy Canary Inspcclor ’s Copy Pink-Finance Copy Gokl-Appikiat*i Receipt