HomeMy WebLinkAbout1985-10-03 Permit, New Water Well #8113GENERAL PERMIT
CITY OF ORONO
CITY PERMIT NO.8113
Owner
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
L612) 473-7^7 ,
Date
Contractor I tT"i(Ck ^ (X
Address
Address
City License No.^ i V
I 'T^OL l+,j
State License No.___________
7 m+licx_
* t
• L
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: □ NEW □ ADDITION □ REPAIR
Inside Plumbing t#fixtures__)
Water Meter (Size
Meter#___
.)
Fee S
Fee S
Remote #.
Municipal Water Connection
DCopper rn
Fee $
Municipal Sewer Connection
□ PVC □ Cast Q
MWee SAC Charge
On Site Septic System
Fee S-
Fee $
Fee S.
Water Well Fee $,^o ct>
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
CJrading. Filling, etc.)
Fee S
Fee S
Fee S.
Fire
Sprinkler System (Fire)
Other:____________
Fee $
Fee S
After-the-fact Investigation
Fee $
Fee S
ACKNOWLEDGEMENT
Th« un4»nlfiicd hmby BcluiawtoddM rmipi of tfUt liaillod
poffmlt. lAchidtaig occoptanco of oD m^ei9X tefomolkMi,
toniit, condltfont or loquiiwaiMiU wditon obovo. tile
underMfoed luideretafidi and epees under penalty of law
tiMt this permit U stiteliy limlled in seope to the woth,
activity or Improvement pecifled; that this permit dnae
not pant any authority to do work or activities requislni
separate permit approvals: and that this permit does not
pant aulhoiily to violate any poviston of any City
ordinanoe or Stale law, rule or repUation. AU work diall he
done In sMet compUance with all City ordlnaneee. buUdlnf
codas and/or haaHh department repUattons. and diaS he
iohlaet to hMpecllon. approval or leiecilon hy the City.
Whenever so ordarad, the undendpmd ^lees to correct
any work found to he In violation of the conditions of
this paonit.
Signature of Aorlicant
TOTAL
State Surcharge:
Total Amount Paid to City
F« .
Fm S O ^
This permit is not valid until tfie proper fee ia paid andl
it is approved by an authorized City Official.
latur^,^ (Signatur^^fT City Offief
wniif . rat Copy Cahify Inipcctar's Copy Phik-nnanca Copy Iff