HomeMy WebLinkAbout1982-08-19 Permit, Septic System Repair #6775GENERAL PERMIT CITY PLRMIT NO. _-6775
CITY OF ORONO Date
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner Address _ ...,,� 4o
Con tractor rl% 4-e-4 �i, Address C
t
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE.
Inside Plumbing ( # fixtures
Water Meter (Size )
Meter #
Remote #
❑ NEW XADDITION
_) Fee $
Fee $_
Municipal Water Connection Fee $
❑ Copper Q
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast n
MWCC SAC Charge Fee $
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 thla 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 nct
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 n11/or health department regulations, and shall be
subject to Inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signatu of AP licant
r
,REPAIR
On Site Septic System Fee $ aJL
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
Sv�
State Surcharge: Fee
Total Amount Paid to City Fee $
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Oft)0al
Code White file Copy Canary Inspector's Copy
Pink - I inance Copy
(wrid Applicant's Receipt