HomeMy WebLinkAbout01-16-1986 Permit, Water Well #8301GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner
CITY PERMIT NO.8301
Address OS
Address.
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE;
Inside Plumbing (i/fixtures__)
Water Meter (Size__)
Meter#______________
□ new □ addition □ repair
Remote
Municipal Water Connection
□ copper n
Municipal Sewer Connection
□ pVC □cast □.
MWCC SAC Cliarge
On Site Septic System
Fee S
Fee
Water Well Fee
Mechanical Equipment Fee
Moving /Lifting Buildings Fee
Land Alteration (Excavation, Fee
Grading, Filling, etc.)
Fire Ppp
Fee !s
rcC o -----------
Fee S.
Sprinkler System (Fire) Fee
Other: Ppc
After-the-fact Investigation FeeFee S
ACKNOWLEDGEMENT TOTAL
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special InformaUon,
terms, condiUons or requirements written above. The
undersigned understands and agrees under penalty of law
that this permit Is strictly limited In scope to the work.
State Surcharce; Fnft S
Total Amount Paid to Citv Fee .s:
acUvity 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 shall be
done In strict compliance witli all City ordinances, building
codes and/or health department regulations, and shall be
sublect to Inspection, approval or re]ection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in vioIaUon of ike condlUons of
This pennit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
this permit.
Signature of Applican^^^--Signature of City Offidal
Code: Wliitc-nic Copy Canary-Inspector’s Copy Pink-I'inancc Copy Gold-Applicant’s Receipt