HomeMy WebLinkAbout1987-07-29 Permit, Septic System #9195I V
GENERAL PERMH
CTTYOFORONO
*
P.O.BOX 66
CRYSTAL BAY. MINNESOTA 55323
(612)473-7157
CITY PERMIT N9 9151
Diie
.*
Owner _
Contractor
City License No.
1 . toizj
Address
Address
City _
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REMARKS AND SPECIAL CO) .tiTTlONS j
PERMIT TYPE AND f=EE
Inside Plumbing (^fixtures_
Witer Meter (Size-----)
Meter#__________
Xn
.)
, sNEW
Fee $
□ REPAIR
Ft
Remote#
Munidpol Witer Cbnnection
□ Copper □ ------
Fee $
Mumdpal Sewer Connection
□ PVC □ QBt □
MWCC SAC Charge
On Site Spetic System
Fee S
□ ADDITION
l^ler Well
Mechanical Equipment
Fireplace/Wood Stove
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading. Filling, etc.)
Design Review
Fire-------------------------
Fee $________
Fee S
□ REMODEL
Fee $ _
F« $ _
F« $ _
Fee $ _
Sprinkler System (Fire)
Other -----------------
AAer-the-fact Investigation
Fee S
Fee S
Fee $
Fee $
Fee $
Fee $
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ACKNOWLEDGEMENT
The underMgncd herrtn acknowlnlses'kxcir'' i/ this limited permit,
indudim taxpiaKe cif dl spr-Mil infcrmatHK' terms, ciindmons ur
requiirmeriB WTitlrn abore. The underafned understands and agrees
under penalty nf law that thts permit is stiictly Hmiied in scope ki the work,
actisity nr impnnrmeni specified', that this permit does ma gram any
authority lodo work nr activities irauaring separate permit approvals; and
that this permit docs not graraauthoaty to violalc any pniviskm cf any City
oedinance or Sate law. rule or regulatina All work ^11 be done in strict
rimpiance with all City ordinances. Kiiiding codes and/or health
depanment regtdations. and shall he sul^ lo inspection, approval rw
rejection bv the City. Whenever so mdered. the undersigned agrees to
correct any work found to be in violation (i the conditions of this permit.
Signatuie of A|n
TOTAL
Stale Surcharge:Fm $
Total Amount Rikl to City Fee $ ISr2)
4
This pe/mit is not valid until the proper fee is paid and it is approved
by an authorized City OflBcial.
of City
Code: While -Fie Copy Caiii.^— Inspcctcrr’s Copy Pink - Fnance Copy Gold—Applicanrs Reoeipi