HomeMy WebLinkAbout1985-7777 - replacement well GENERAL PERMIT CITY PERMIT NO. 7777 ,
CITY OF ORONO Date
P.O.BOX 66
CRYSTAL BAY,MINNESOTA 55323
(612)473-7357
Owner PlaEc k G klol f Address-1020 ,Q V e 4,uA
Contractor s-t�v� Address / -IN
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
E5L L
PERMIT TYPE AND FEE: NEW ❑ ADDITION ❑REPAIR
Inside Plumbing (#fixtures_) Fee $ Water Well Fee $
Water Meter(Size_) Fee $ Mechanical Equipment Fee $
Meter#
Remote# Moving/Lifting Buildings Fee $
Municipal Water Connection Fee $ Land Alteration (Excavation, Fee $
❑Copper 171 Grading, Filling, etc.)
Municipal Sewer Connection Fee $ .
Fire Fee $
❑ PVC ❑Cast �_ Sprinkler System (Fire) Fee $
MWCC SAC Charge Fee $ Other: Fee $
On Site Septic System Fee $ After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions or requirements written above. The a State Surcharge: Fee $
undersigned understands and agrees under penalty of law g
that this permit is strictly limited in scope to the work, j U
activity or improvement specified; that this permit does
not grant any authority to do work or activities requiring Total Amount Paid to City Fee
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 shall be
done in strict compliance with all City ordinances,building
codes and/or health department regulations, and shall be This permit is not valid until the proper fee is pa d and
subject to inspection, approval or rejection by the City. It 1S approved b an authorized Cit Official.
Whenever so ordered, the undersigned agrees to correct pp Y Y
any work found to be in violation of the conditions of
this permit.
Signature of Applicant Signature of City Official
Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt