HomeMy WebLinkAbout1986-05-20 Permit, New Water Well #8477CGENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner /_ taO'AD '-]& it '�l IIY-A L/<1
Contractor �s kL1:e'as
City License No.
REMARKS AND SPECIAL CONDITIONS
0
PERMIT TYPE AND FEE
Inside Plumbing Ofixtures_)
Water Meter (Size—)
Meter k
Remote N
CITY PERMIT NO. 8477
I
Date �� c9&
Address 11-5-0-7
Address
❑ NEW ❑ ADDITION
Fee S
Fee S —.- — --
Municipal Water Connection Fee S
❑C'opper ❑
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast r-
MWCC SAC Charge
On Site Septic System
ACKNOWLEDGEMENT
Fee $__
Fee S
The undersigned hereby acknowledges receipt of" limited
permlt. Including acceptance of all special information,
tem c conditions or requ:remertta written above. The
undersigned understands and agree under penalty of law
that We payroll is strictly Ilnrited is scope to the work,
activity or improvement specllieM that this permit don
not grant my authority to do work or activities requiring
espante permit approves: and that this permit don not
grant authority to violate any provision of any city
ordinance or State taw, rule or regulation. ALL work shall be
done in strict compliance with as City ordinances, building
codes and/or health department regulations. and @ball be
mbJect to bwPaction, approval or resection by the City.
Whenever so ordered, the undersipted agrees to correct
any work !ound to be in violation of the conditions of
this permit.
State License No.
❑ REPAIR
ter Well
anical Equipment
/Lifting Buildings
ILand Alteration (Excavation.
Grading. Filling, etc.)
kler System (Fire)
Investigation
TOTAL
Fee S 30 (V
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
State Surcharge: Fee Ssp
Total Amount Paid to City Fee Ste_
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
of City
Code. White File Copy Canary- inspectors Copy Mak-Finance Copy Gold -Applicant's Receipt