HomeMy WebLinkAbout1982-08-12 Permit, New Water Well #6767GENERAL PERMIT
CITY OF ORONO
CITY PERMIT NO. ~ 6767
Owner.
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)47p357
Date.
Ta /jyfiO ,
Contractor /I//tG^^AArvv^ ^‘^^0 Z^l)// Xi!2. //I
(jyK^ 0/i64^y=^/o Address.
City License No..State License No.
01MARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE:
Inside Plumbing ( # fixtures.
Water Meter (Size__J
NEW □ ADDITION □ REPAIR
)Fee $.
Fee $.
Meter #_
^ Remote #
Municipal Water Connection
Q Copper Q____
Fee $,
Municipal Sewer Connection ^
□ PVC □ Cast □__!
Fee $.
MWee SAC Charge Fee $.
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S_________
Fee
Fee $_________
Fee S_________
Fee $_________
Other:,
After-the-fact Investigation ''W
Fee S.
Fee S V
ACKNOWLEDGEMENT
Tti« undenigntd hertby acliiiowtedtii ttctipl of Ihli UmlUd
pcimlt« includini acccpUncc of all 9tcial lofoimatloii,
taems, conditions or rcquiftmtnto wsitten abovt. Hit
undtrMgntd undantands and apitta under ptnalty of law
that this permit is strictly limited in aeope to the work*
activity or improvement specdBcd; that this permit does
not irant any authority to do work or activities requiring
separate permit approvals: and that this permit does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. AH work shall be
done in strict compliance with all City ordinancea. building
codes and/or health department regulations, end shaU be
subiect 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.
Signatiirc^LAikpli-^Ix.ilieant
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S.
Fee
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signatu:MTCity Official/^
/-y
Code: White-rUc Copy Cinary - Inspector*! Copy Pink-llnancc Copy Gold-Applicant’s Receipt