HomeMy WebLinkAbout1982-09-24 Permit, Septic Repair #6824GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 6824 1
Date — ;�? — oZ
Owner - /It C_ M, llax,.. Address U � �� eL-_�
Contractor �U 1 jZAddress O U/ So
City Lic ;e No. State License No. _
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: ❑ NEW
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter #
Remote #
❑ ADDITION
Fee $
Fee $
Municipal Water Connection Fee $
❑ Copper
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast i 1
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
nut grant any authority to do work or activities requiring
separate permit approvals; and Liat this permit 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 endlor health department regulations, and shall be
wrbject to inspection, approval or rejection by the City.
Whenever so ordered, the •.mdersigned agrees to correct
•ny work found to be In violation of the conditions of
this permit.
Si ai'tt e of Ap icant ,
M REPAIR
On Site Septic System Fee S Od
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
State Surcharge:
Total Amount Paid to City
Fee S • SO !
Fee $ () d 1
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
jign'lture of City Official
� _- _
Code: White - Tile Copy Canary Inycctor's Copv
Pink I inance Copy Gold Applicant's Receipt