HomeMy WebLinkAbout1982-07-23 Permit, New Water Well #6749GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(613) 473-7357
Owner—A,l �JdvlfeV-2
Contractor
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE:
Inside Plumbing ( # fixtures
Water Meter (Size )
Meter # _
Remote #
Municipal Water Connection
❑Copper ❑
Municipal Sewer Connection
❑ PVC ❑ Cast ❑
ONEW
❑ ADDITION
Fee $
Fee $
Fee $
Fee $
CITY PERMIT NO. 6'749 1
Date :2,3
Address 44475 ,9/100 i 9 Je • So
Address % e
State License License No.
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee $
Fee $ ��
Fee $
Fee $
Fee $
Other: Fee $
MWCC SAC Charge Fee $ After -the -tart Investigation Fee $
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions or requirements written above. The
undersigned 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 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. All work shall be
done in strict compliance with all City ordinances, building
codes and/or health department regulations, 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 the conditions of
this permit.
Signature of Applicant
u, o
Code: White -File Copy Canary —Inspector's Copy
TOTAL
State Surcharge:
Total Amount Paid to City
Fee $ ' �
Fee $ �? �n
This permit is not valid until the proper fee is paid and
it is approved by an authorizeti City Official.
Signatu f City Official
Pink — I-inance Copy Gold Applicant's Receipt