HomeMy WebLinkAbout1986-07-07 Permit, Water Well #8552GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner,
Contractor____
City License No..
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CITY PERMIT NO. 8552
Date.
Address
Address
A^iCijp ^cl
State License No.
REMARKS AND SPECIAL CONDITIONS
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PERMIT TYPE AND FEE:
Inside Plun.bing (^fixtures __)
Water Meter (Size__
Meter#_____________
□ NEW □ ADDITION □ REPAIR
Remote
Municipal Water Connection
QCopper Q____
Municipal Sewer Connection
□ pVC DCast Q.
MWCC SAC Charge
On Site Septic System
Fee S Water Well Fee
Mechanical Equipment Fee
Moving /Lifting Buildings Fee
Land Alteration (Excavation, Fee
Grading, Filling, etc.)
Fire Fee
Fin* 5; _____
Fee S.
Ft*i* ^
Sprinkler System (Fire) Fee
Other: Fee
After-tlie-fact Investigation FeeFet! 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 strictly limited In scope to the work,
activity or improvement Q>ecified: 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. AU work shall be
done in strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subiect 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
thU permit
_SignaJuiiiuof Annlic^/^
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S.. 5D
Fee S2) j
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signati^of City Official
Code: WIiltc-MIc Copy Canary-Inspector’s Copy Pink-Finance Copy ^jold-AppUcant’s Receipt