HomeMy WebLinkAbout1982-09-22 Permit, Septic System Repair #6818GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner-4- ��G- Address _
Contractor !dJ[J'es:4 &a, &!12? Address _
City License No,
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION
Inside Plumbing ( # fixtures ) Fee $
Water Meter (Size )
Meter #
Remote #
Fee $
Municipal Water Connection Fee $
❑ Copper
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast ❑__
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee $
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
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 andhealth 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 ;fAp 'cant j q
sor ice'
CITY PERMIT NO. s81S
Date 0�w, (f0
�e
State License No.
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REPAIR
On Septic System Fee $
Water Well Fee $
Mechanical Equipment Fee $
Moving,/Lifting Buildings Fee S
Land Alteration (Excavation, Fee $
Grading, Filling, etc.)
Other: Fee $
After -the -fact Investigation Fee $
TOTAL
State Surcharge: Fee $
s-0
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 Official
Code: White - Idle Copy Canary - inspector's Copy rink -Finance Copy Gold - Applicant's Receipt