HomeMy WebLinkAbout1984-10-10 Permit, Water WellGENERAL PERMIT
CITY PERMIT NO. 7648
CITY OF ORONO Date
P.O.BOX 66
CRYa fAL BAY, MINNESOTA 55323
(612) 473-7357
'1 1r
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`/ C 71 /� `C._ Address '17 l/
Owner
fl �) l Address'
Contractor 1 -T
City License No.State License No.
REMARKS AN SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
Water Meter (Size—)
Meter#
Remote #
�iIFW ❑ ADDITION ❑ REPAIR
Fee S Water Well
Fee S _ Mechanical Equipment
Municipal Water Connection Fee S _
❑Copper F_
Municipal Sewer Connection Fre S
❑ PVC ❑ Cast n
MWCC SAC Charge Fee S _
On Site Septic System
ACKNOWLEDGEMENT
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading. Filling. etc.)
Fire
Sprinkler System (Fire)
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S After -the -fact Investigation Fee S
The undersigned hereby acknowledges receipt of this limited
permit. including acceptance of all special information.
terms. conditions or requirements written above. The
undersigned ur..ferelands and agrees under penalty of law
that this permit is strictly limited In scope to the work.
activity at improvement speeirted'. that " permit does
not grant any authority to do work or activities requiring
separate permit approvals: and that this permit don not
grant authority to Notate any provision of any City
ordinance or State taw. rule or regulation. All work shall be
done In strict compliance with all City ordinances. building
codes and/or health department regulations. and sball 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 Applicant
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TOTAL
State Surcharge: Fee S ' SD
Total Amount Paid to City Fee SD. -S -Z;
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
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Code: White - File Copy Canary -Inspector's Copy Pink- Finance Copy Gold -Applicant's Receipt