HomeMy WebLinkAbout1984-09-19 Permit, Septic Repair #7618GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
61' 473-7357
CITY PERMIT NO. 7618
Date9- /�_ - / I /
Owner
• Address _1s.1S� _ z1a�
Contractor Address
City License No. State License No,
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
Water Meter (Size—)
Meter#
Remote#
❑ NEW ❑ ADDITION
Fee S
Fee S
Municipal Water Connection Fee S __-----
❑ Copper n
Municipal Sewer Connection Fee S--
❑ PVC ❑ Cast n
MWCC SAC Charge Fee S _ _2_--
On Site Septic System Fee Ste(/,
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 pennit does not
giant authority to violate any provision of any City
ordinance or State law, rule or regulation. Ali work shall be
done In strict compliance with all City ordinances, building
codes and/or health department regulations, and &hall be
subject to inspection, approval or rejection by the Citv.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signatow,4. Applicant
KREPAIR
Water Well
anical Equipment
',Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fire
Sprinkler System (Fire)
then.
Fee
S 3
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
fter-the-fact Investigation Fee $
TOTAL
State Surcharge: Fee S
Total Amount Paid to City Fee S 36. S
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Sign u e of City Offic'�
Code: White File COPY Canary- Inspector's Copy Pink —Finance Copy Gold —Applicant's Receipt