HomeMy WebLinkAbout04-19-1982 Permit, Water Well #6656GENERAL PERMIT
CITY OF ORONO
CITY PERMIT NO.
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Date.
6656
Owner.tharles dff/as
Contractor.
City License No..
.Sladold
Address.
Address.
''Ar/c
/Vjhnp/7)ntrx ^_______
State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE:
Inside Plumbing ( # fixtures.
Water Meter (Size____)
□ NEW □ ADDITION
_) Fee S________
Fee S________
Meter #.
Remote #
Municipal Water Connection
D Copper n----
Fee S_
Municipal Sewer Connection
□ PVC □ Cast Q.
Fee S.
MWCC SAC Charge Fee S.
□ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Fee S.
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S.
Fee $
Fee S
Fee S
A/f).no
Other:.
After-the-fact Investigation
Fee S.
Fee S,
ACKNOWLEDGEMENT
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 sirlcdy limited in scope to the work,
acUvity or improvement specified; that this permit docs
not grant any authority to do work or activities requiring
separate permit approvals; and that this permit docs not
grant authority to violate any provision of any City
ordinance or SUtc 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
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 of Applicant
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S.
Fee s:
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Sigimture of City Official
Code: Whitc-HIe Copy Canary-Inspector’s Copy Pink-l‘inancc Copy Gold-Applicant’s Receipt