HomeMy WebLinkAbout1982-08-16 Permit, Septic System Repair #6769GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner ______________
CITY PERMIT NO. . 6769
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Contractor,y^'\>
Address _ ^ ?c^ fS >C
Address ^ /A/ Cr
City License No..State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: □ NEW □ ADDITION
Inside Plumbing ( # fixtures____) Fee $________
Water Meter (Size____) Fee $________
Meter #______________________
Remote #
Municipal Water Connection Fee $.
□copper n
Municipal Sewer Connection
□ PVC □ Cast Q
Fee $.
MWCC SAC Charge Fee $.
J^REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee $
Fee $______
Fee $______
Fee $______
Fee $______
Or»
Other:
After-the-fact Investigation
Fee $
Fee $
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of aU 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 permit does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. All work ^all be
done in strict compliance with all City ordinances, building
codes and/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.
Signature^f Applicant ^
TOTAL
State Surcharge:
Total Amount Paid to City
Fee $,
Fee $_20^
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-FUe Copy Canary-Inspector’s Copy Pink-l inance Copy Gold-Applicant's Receipt