HomeMy WebLinkAbout1984-10-10 Permit, New Water Well #7649GENERAL PERMIT CITY PERMIT NO. 7649
CITY OF ORONO
11(1 BOX (Ih Date tf _
CRYSTAL BAN, MINNESUTA 553:3
1 (612) 473-7357
Owner
r 4Address
Contractor Address
City License No. 4
1
7 State License No.
RFMARKS ND SPI-.CIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixturrs_I
Water Meter (Site_)
1
deter#
Remote I
NEW ❑ADDITION ❑REPAIR
Fee S _ )Water Well
Fee S — _ _ _- IMcchanical Equipment
Municipal Water Connc:lion Fre S _
❑Copper ❑
Municipal Sc%cr Connection Fre S _
❑ PVC ❑cast n_
MWCC SAC Charge Fee S
On Site Septi): System
ACA NOW LEDGEMENT
L71.
Fee S�
Fee S
oving !Lifting Buildings Fre S
nd Alteration (Excavation. Fee S
Grading. Filling, etc.)
re Fre S
SyNcm (Fire)
Fee S -- jAfter•the- fact Investigation
The underuaned herrbs acknowkdps mrotPl rel thu Itmlud
Pearn, utcludtng —qLm- of all -p.cftd lnfotm.Uon,
t.M., c-tndlunn. w naulr.mrna .roan abn,r Thr
underdgned understanda and agree. und.r Mnalh of I..
that thU Penn), 1. -tnc Ut Umlfed to .op. to the awk.
.w Im Pro,em.nt wecttud. that thf- P-M,t dors
now grant N- wthunh to do wow► w acu,tue. reputnng
r POatr P.hnft -rPnoal.. and that Nu P.nnll dna- nal
atant au UtontY u, t/ul.t. Ylt pro,ttlan of ant C�It%
i wdfnanee of SLAW lar, mir of regulation. AU wwk shill he
dove In strict romptimce with aU t'Itc ordinance.. buUdtng
—de. u-drar health d.Ptutmrnt regulation-. and -h.11 be
aubiect to Inspe<UtM, appro,al w MWUon be Nr fits.
Whene,n -. wd—d. the undrragnrd agree. to --1
and work lound 1.. 1,r m NolaU— at the <undlUont of
thl. Pt -i,
Signature of Applican��
TOTAL
Fee S
Fee S
Fee S
State Surcharge: Fee S • ��
total Amount Paid to City Fee S�
This permit is not valld untll the proper Ire 1% pard and
it is approved by an authonicd City Official.
Sign rr of City Offic" 1 - s
Code; Wwrg—t'llit Copy Canny -It VKlot's CPP, Rn► t groat,. C cop> Gold Applkam'g 0 1 -