HomeMy WebLinkAbout1983-07-20 Permit, Replace Water Well #7072t ►►, Irl k\tl I ' � , -- 1
GENERAL PERMIT 0721
CITY OF ORONO
P.0.11t I\ oo
CR) STAL BAY. %II\NESOTA 55323
1612)473-7357
owner
Contractor ; i' . , _ _{1� Addre%s
City License No. State Llcenx No.
Rl NARKS AND SPECIAL CONDITIONS
1'1 RN17 Tl Pf :\\D F1 1 ❑ NFW ❑ ADDITION
Imide Plunlbilig 1 s t1%turc%_) Fee S
Water Meter 1 Site—) Fee S
Meter t+ —
Remote 4
Nuulk.tpal Nater Connection Fee S
❑Copper Q --
Municipal Sewer C'omwt:uon Fee S
❑ Pvc ❑ l'j,1 n _---
M:YCC SAC Clwige Fee S
ACKNOWLEDGL•N1:NT
Thr unJ•rYnnrJ hrrrbt atk... MJg.• nr jpw„uthis limited
p•nwrt. 1-1.4-1 .rrlplI—t
of rV .Pe•
t.mt.. ...ndltirm. rN nquifefn.rtti .return b-1, Tt.
uhderuyr.l undenwada and eae.e under P 411 .f Ira.
that this penrllt 1s etiitlll ttratwd to w"W to th. ...k.
ec Utttr or Unpm"ment w"Ified: that this hetmu 4.w.
n-.tgrant W. eutnr.itl to dre .ark nr ee ti•tw. repulrtng
rvu.tr Permit gpprotal.. and Wat Wu prrrnrt do.. nut
Went .0 h.r/lr to alae, Wf p.u.tiun ul an, CIIV
oedirt.nr. or %taw la.. rule - regulation. all .ark ahem be
lone In .taft eumphenr. .ith ea Cit* urdtnutt... buddtn$
eud.s sndlor health drpettla..t n{ulatiuro. Wd .heh a
eubwt to In.pet U,.n. Wprmal up rei.rtiun br th Call.
,h h.nr.•r .0 ordrn4. N• undersigned .gn.. to run.tt
enc .,,rk 1, nd 1„ is, an ttol.u.m .,f the ,..ndtu ,n, ..1
thla prmut.
ature 01plican y
i ZiZ ✓ /11y
l'utk Massie 1 ik Cury
Ujrw> trisr"'W-I Cup*
❑,
Rl PAIR
On Site Septic Systenl
Fee
S --
S
Water well •-
Fee
Mechanical Equipment
Fee
S
mosing/Lifting Building.
Fee
S
Land Alteration IFxcatauuil.
Fee
S
Grading. Filling, etc.)
Other
Fee
S
After-the•la.t Imestigition
Fee
S_
Iul-AL
SWte sumbirge:
Total Anwunt Paid to City
!;7�
Fee
Fee Ste=
This pennit is not valid until the proper tee is paid and
it is approved by an authorized City Official.
Signature of
Pini 1 iftgece ('taps t;uw Ap w"I'. Remipt