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1985-07-26 Permit, Water Well #8008
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1985-07-26 Permit, Water Well #8008
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Last modified
4/3/2025 2:48:12 PM
Creation date
4/3/2025 2:34:47 PM
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Template:
x Address Old
House Number
2565
Street Name
Countryside
Street Type
Drive
Address
2565 Countryside Drive
PIN
0411723110011
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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner W f I CA 0 �Iohmcw) �TU2;)'e%,U0r_A' <br />Contractor—To r 5eyson We I l La. J L3 f\ <br />City License No, <br />rq(.ol <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: X NEW ❑ ADDITION <br />Inside Plumbing (#fixtures_) Fee S <br />Water Meter (Size_) Fee S <br />Meter# <br />Remote # <br />Municipal Water Connection Fee S <br />❑Copper ❑ <br />Municipal Sewer Conuection Fee S <br />❑ PVC ❑ ( ast r— <br />MWCC SAC Charge Fee $ <br />On Site Septic System Fee S <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledMs receipt of this limited <br />Permit. including acceptance of all special information. <br />terms, conditions or requirements written above. The <br />undersigned understands and agrees under penalty of law <br />that this permit is strictly limited in scope to the work. <br />activity or improvement specified. that this permit does <br />not grant any authority to do work or activities requiring <br />separate permit approvals; and that this permit does not <br />grant authority to violate any provision of any City <br />ordinance or State law, rule or regulation. All work shall be <br />done in strict compliance with all City ordinances, building <br />codes and/or health department regulations, and shall be <br />sublact to Inspection, approval or resection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Signature of Applicant <br />OIC14 -. ln-1 <br />CITY PERMIT NO. 8008 <br />Date 7 - c� Co~ &5 <br />o?5Co5 Coun4rtj51de_ ,ter. <br />Address 1 <br />Address (P955 !��vood $+� <br />. /� A'!eld <br />7►'l V 55 3 73 <br />State License No. '9,765(o <br />❑ REPAIR <br />Water Well <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />I -and Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fire <br />Fee $ ,� • Qd <br />Fee S <br />Fee S <br />Fee $ <br />Fee S <br />rinklerSSyMail- <br />stem (Fire) Fee S <br />/ <br />hes. (+ IaI l - in Fee $ r' 50 <br />fter-the-fact Investigation Fee S <br />TOTAL <br />State Surcharge: Fee $ _ -6�) <br />Total Amount Paid to City Fee $ - °_U() <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City Official <br />TC17 c�C/r1.1W <br />Code: White—File Copy Canary —Inspector'r Copy Pink—Finance Copy Gold—Applicant's Receipt <br />
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