HomeMy WebLinkAbout1982-04-06 Permit, Septic System Repair #6644GENERAL
PERMIT
CITY
OF
ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
1)
Owner _
('ITY I'l RNIIT N0. 6644 �
Date y -
Address /20 S� S' , nr2oturJ kt:> .
Contractor 6.1 P43TL1AXX>..J Co, Address �e*N
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FLL: ❑ Nl W
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter # _
Remote #
'1� Qa>ti
❑ ADDITION
Fee S
Fre S
Municipal Water Connection Fee $
❑ Copper
Municipal Se"'rr ( unneetion Fee S
❑ PVC ❑ C.i,t F1
MW('(' SAC ('har_,r Fee S
ACKNOWLEDGEMENT
The undersigned hereby acknowledges 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 or 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
subject t,, inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agnea to correct
any work found to be in violation of the conditions of
this permit.
Signature of Appl;cant
Code. White I dr Copy Canary Inspector's Copy
State License No.
--%-e
;ZREPAI R
On Site Septic System Fee $
2-�
Water Well Fee $
Mechanical Equipment Fee $
Moving/Lifting Buildings Fee $
Land Alteration (Excavation, Fee $
Grading, Filling, etc.)
Other: Fee $
After -the -fact Investigation Fee $
TOTAL
State Surcharge: Fee $ �—
Total Amount Paid to City Fee � ZO
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of Ityy Official
Pink - finance Cop)
(„ rid Applicant's Receipt