HomeMy WebLinkAbout03-05-1986 Permit, Water WellGENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
CITY PERMIT NO.
Date
8372
Owner ^^
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City License No -------------
Address
State License No..
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE:
Inside Plumbing (^fixtures__)
Water Meter (Size—)
Meter#_____________
NEW □ ADDITION □ REPAIR
Remote#.
Municipal Water Connection
DCopper n
Municipal Sewer Connection
□ PVC DCast □.
MWee SAC Charge
On Site Septic System
Fee S
Fpp s;
Water Well Fee
Mechanical Equipment Fee
Moving /Lifting Buildings Fee
Land Alteration (Excavation, Fee
Grading, Filling, etc.)
Fire __ Fee
Fpc 5:
Fee S
Fpp Is _________
Sprinkler System (Fire) Fee
Other: . _ Fee
After-the-fact Investigation FeeFee S
30.00
ACKNOWLEDGMENT
The undersifned hereby ecknowlediet receipt of this limited
permit. Including eccepUnce of all ^edal Information,
terms, condlUons or requiremenU written above. The
underlined understands and afrees under penalty of law
that this permit is strictly limited in scope to the work,
activity or improvement specified; that this permit does
not grant any authority to do work or activities requiting
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 worii 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 $..SO
Fee ^
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
Code: Whitc-FiIc Copy Canary-Inspector’s Copy Pink-Finance Copy Gold-Applicant’s Receipt