HomeMy WebLinkAbout1984-08-22 Permit, New Water Well #7578GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNKSOTA 55323
(612)473-7357
CITY PERMIT NO. ' 757S •
Date
Owner TuU Address
Contractor y)
City License Nn. S
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AJdress /nTt'/O //uy /.3 U-^ ' /K !■
State License No
REMARKS AND SPECIAL CONDITIONS
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PERMIT TYPE AND FEE:
Inside Plumbing ( # flxtua's.
EW □ ADDITION □ REPAIR
Fee S.
Water Meter (Size
Meter __
.)Fee S,
Remote #
Municipal Water Connection Fee S.
□c opper
Municipal Sewer Connection
□ pVC ncast D
Fee S.
MWee SAC Charge Fee S,
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:,
After-the-fact Investigation
Fee S
Fee S.
Fee S.
Fee S
Fee $
Fee S.
Fee $,
ACKNOWLEDGEMENT
Tht undenlgned hereby acknowledges receipt of this DTnIted
permit, including Mceptence of ail special Information,
lams, condUions or requirements written above. The
undersigned unoterstands 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 activities requiring
separate permit approvals; and that this permit does not
grant authority to violate any pro\'ision of any City
ordinance or State law, rtUe or regulation. All work shall be
done In strict compliance with all City ordinances, budding
codes and/or health department regulations, and shall be
subiect to Inspection, approval or leiection by the City.
Whenever so ordered, the undenlgncd agrees to correct
any work found to be in violation of the conditions of
ibtj permit.
Signatare of Applicant
TOTAL
State Surcharge:
Total Amount Paid to City
Fee $
Fee $
SO
20 SD
This pennit is not valid until the proper fee is paid and
V ,4* approved by an authorized City Official.
Signa
Code Sfhit* I lie Copy f *anar>' Inspet inr** Copy Pink Hnance Copy (iold AppUcanCs Receipt
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