HomeMy WebLinkAbout1985-06-04 Permit, Septic Repair #7941GFNERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner
Contractor _Z7 LC.CJT�� lx a�
City License No. 0aa 00
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
Plater Meter (Size
Meter# _
Remote #_
CITY PERMIT NO. 7941
Date L _
Address
Address
❑ NEW ❑ ADDITION
Fee S
Fee S
Municipal Water Connection Fee S --
❑Copper
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast Q
MWCC SAC Charge Fee S
� On Site Septic System
ACKNOWLEDGEMENT
Fee S—1—b- 60
The undersigned hereby acknowledges rereipt of this limited
permit, Including acceptance of all special information,
terms, conditions or requiremenis written above. The
undersigned understands and agrees under penalty of law
that this permit is strictly Umitei 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 Isw, 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
subi-et to inspection, approval or rejection by the City.
Whenever to ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
S1911a
/t7ure of Applicant
Code: White -File Copy Canary -Inspector's Copy
State License No.
REPAIR
ater Well Fee S
'Mechanical Equipment
Fee S
Moving /Lifting Buildings
Fev S
Land Alteration (Excavation,
Fee S
Grading, Filling, etc.)
Fire
Fee S
Sprinkler System (Fire)
Fee S
Other:
Fee S
er-the-fact Investigation Fee S
TOTAL
State Surcharge: Fee S '
Total Amount Paid to City Fee S SQ' 5V
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signa re of City O ficial
Pink -Finance Copy Gold -Applicant's Receipt