HomeMy WebLinkAbout1982-12-23 Permit, Water Well #6911GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner
Contractor.Slfj/pn\ /jhJ!
City License No..
RE.MARKS AND SPECIAL CONDITIONS
Address,
CITY PERMIT NO. __ 691 i •
Date
Atildur Park Rd.
Address ___________________
State License No.
PERMIT TYPE AND FEE
Inside Plumbing (fixtures
Water Meter (Size____)
Meter If__________
: ^NEW □ addition □ REPAIR
Fee S.
Fee S.
Remote #
Municipal Water Connection
□ copper □------
Fee S_
Municipal Sewer Connection
□ PVC □ Cast □.
Fee S.
MWee SAC Charge Fee S_
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
permit. Including acceptance of cU special infonnatlon,
terms, conditions or requirements written above. The
underlugned understands and agrees under penalty of law
that this permit Is strictly limited In scope to the work,
activity or Improvement specified; that this permit does
not grant any authority to do work or acUvlUcs requiring
separate permit approvals; and that this permit docs not
grant authority to \iolate any provision of any City
ordinance or State law, rule Or regulation. AU work shall be
done in strict compliance with all City ordinances, budding
codes and/or health department regulaUons, and shall 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 tlie conditions of
this permit
Signaturee of^plicaiW
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:_
After-the-fact Investigation
Foe S__________
Fee S
Fee S__________
Fee S---------------
Fee S--------------
Fee S_________
Fee S ^D-^0
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S..SO
Fee S ^o.so
This pennit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Sigtiatlire of City Off^iSh \
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Code: Wliitc-file Copy Canary-Inspcciur’s Copy Pink-l inance Copy Gold-Applicant’s Receipt