HomeMy WebLinkAbout1984-06-19 Permit, Septic Repair #7468GENERAL PERMIT
CITY OF ORONO
P.O.BOX 60
CRYS1 AL BAY, MINNESOTA 55323
(61 _) 473-7357
Owner V,4,e- Address
('ITY PI RMIT NO. + 7468
('ontrat: tor -ILt LL) %A4N-' Address _ ^
City License No.
REMARKS AND SPECIAL CONDITIONS
Date -/ - 4 F;,'V
State License No
-- S L(J ?Tz-4 OyLs^- Lc.tity 772) t-kr11,K_
PERMIT TYPI- AND FI.F.: ❑ NF:W
Inside Plumbing I .!? listures I
❑ ADDITION
Fee S
Water ,Meter (Site ) Fee S
Meter 4 _
Remote td
Municipal Water Connection Fee S
❑Copper Q__
Municipal Se%cr (ouncction Fee S
❑ PVC ❑ (.ast Q___.
MWCC SAC('harl'e Fee S
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
Permit. including acceptance of all special information,
terms, conditions or requiremen is written above. The
undersigned understands and agrees under penalty of taw
that this permit is stricd> limited in scope to the work,
activity or improvement specifted: that this permit does
not giant any autinority to do work or activities requiring
sepamit approvals: and that this permit does not
rate per
Rant authonty to violate anv provision of any City
ordinance or State law, rule or regulation. Ali work shall be
done m .tract compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subject to Inspection, approval or relection by the City.
Whenever so ordered, the undersigned agrees to correct
env work found to be to violation of the conditions of
this permit.
Signa of Ap ,:ant r
OEPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling!, etc.)
0.0
Fee S 3O j
Fee S
Fee S
Fee S
Fee S
Other: Fee S
After -the -tact Investigation Fee S
TOTAL
S-a
State Surcharge: Fee S
STa
Total Amount Paid to City Fee S r
This permit is not valid until the proper tee is pair) and
it is approved by an authorized City Official.
Signature of City Official
tonic While I de tbpy Canary In". ctor's Copy Rnk I inante Cop% t,uld Applirant'v Reccipt