HomeMy WebLinkAbout1986-08-04 Permit, New Water Well #8589GENERAL PERMIT
CITY OF ORONO
CITY PERMIT NO.8589
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
, (612)473-7357
Date
Owner ;c-?><.va-€-
Con tractor
City License No-------
Address
Address
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State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: □ NEW □ ADDITION □ REPAIR
Inside Plumbing (#fixtures __)Fee S
Water Meter (Size
Meter#___
.)Fee S
Remote #,
Municipal Water Connection
D Copper ri
Fee S
Municipal Sewer Connection
□ PVC □ Cast Q
MWee SAC Charge
On Site Septic System
Fee S
Fee $
Fee S.
Water Well Fee $
Mechanical Equipment
Moving /Lifting Buildings
Fee S
Fee $
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee $
Fire
Sprinkler System (Fire)
Other:____________
After-the-fact Investigation
Fee $
Fee S
Fee $
Fee $
i *
ACKNOWLEDGEMENT
Tilt undtnlpitd lititliy acknowltdiu itctlpi of ihAi Umittd
ptimit. indudlBi tectpltne# of all infoimatloii,
Itmt, coaditiont or itquirtnitnU wdttan tbovt. Tht
tandardintd UBdertUndi and tgittt uiidtr pantlty of law
that this pttnil is strictly Umittd in scope to tht work,
activity or Improvement vedfled; that this permit dots
not grant any authority to do work or activitits rtquiring
sapetate permit approvals; and that this permit does not
grant authority to violate any provision of any City
ortUnance or State law, rule or regulation. AU work shall be
dona in strict compliance with aU City ordinances, building
codas and/or health department regulations, and shall be
aubicct to inspection, spprcnral or leiection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in \1olation of the conditions of
this permit.
SignJi^retLof App cant
TOTAL
State Surcharge:Fee S
Total Amount Paid to City Fee t
This pennit is not valid until the proper fee is paid and
it is approved by an audiorized City Official.
Signature of^Aty Official
Code; White-FUe Copy Otiury-Inspector's Copy Pink-Finance Copy Applicant't Receipt