HomeMy WebLinkAbout12-19-1984 Permit, Water Well #7763GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner ^
CITY PERMIT NO.7763
Contractor.
City License No..
Address S^O .^h)/ Acj-hr>n U3<X^
Address /L>1 cV 7<o/
State License No----------------------------------------------------
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: □ NEW □ ADDITION □ REPAIR
Inside Plumbing (#fixtures —)
Water Meter (Size__)
Meter#_______
Remote #.
Municipal Water Connection
n Copper Q___
Municipal Sewer Connection
□ pVC DCast □.
MWee SAC Charge
On Site Septic System
Fee S
F(»P 5;
Water Well Fee
Mechanical Equipment Fee
Moving /Lifting Buildings Fee
Land Alteration (Excavation, Fee
Grading, Filling, etc.)
Fire Fee
F pp S_____
Fee S
Fee 5; _ _
Sprinkler System (Fire) Fee
Other: Fee
After-the-fact Investigation FeeFee S
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions or requirements written above. The
underdgned understands and agrees 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 requiring
separate permit approvals: and that tUs permit docs 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
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 AppliMnt ^
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S__
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
(7
CodcMVliitc-File Copy Canary-Inspector ’s Copy Pink-Finance Copy Gold-AppUcant ’s Receipt