HomeMy WebLinkAbout1985-07-15 Permit, New Water Well #7985GENERAL PERMIT CITY PERMIT NO. 79855
CITY OF ORONO Date �
7_,_PS
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner /Q moo" ew— saNk� Address tale, 14,. D
--)
Contrai,tor -�'0ti --s;.�0C34 Address / 21l A
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: YJNEW ❑ ADDITION ❑ REPAIR 04
Inside Plumbing (#fixtures_) Fee S Water Well Fee S 3D
Water Meter (Size—)
Meter #
Remote #
Municipal Water Connection
❑Copper
Municipal Sewer Connection
Fee S Mechanical Equipment
Moving /Lifting Buildings
Fee $___ Land Alteration (Excavation,
Grading. Filling, etc.)
Fee S __ ` It ire
❑ PVC ❑ Cast Q—
MWCC- SAC Charge Fee S . --_--
� On Site Septic System
ACKNOWLEDGEMENT
kler System (Fire)
her:
Fee S (After -the -fact Investigation
The undersipted hereby acknowledges receipt of this limited
perm IL including acceptance of an special lnformaaon.
terms. conditions or requirements wdttee above. The
undersped us&can& sod .pees under penalty of low
that this permit is strietb nrMtad to scope to the wart.
n Uvlty or Improvement speeinsd. that this permit don
nal pool any authority to do work or activities repuirieg
separate permit approvals. and that this perrnll don not
grant authority to violate any provision or any C/ty
ordinance or State law. rule or regulation. An work shall be
does in strict eampnanco with all City ordinances. building
codes and/or health depastmeal regulation, and tall be
subject to htepeetios. apprrrval or rebetoe M 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
Fee S
Fee S
Fee S
Fee
S
Fee
S
Fee
S
Fee
S
SD
State Surcharge: Fee S
S�
Total Amount Paid to City Fee S
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signal Ci Official
AV
Code: white -He Copy Canary -Ingmeor s Copy Pink -Finance Copy Gold -Applicant'. Receipt