HomeMy WebLinkAbout1986-06-04 Permit, New Water Well #8502GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner L)t iri n • S
Contractor 6fli 4'-N4
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: NFW
Inside Plumbing (#fixtures_) Fee S
CITY PERMIT NO. 8502
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Date
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Address /I /Y') 011.r /'fid '5o -
Address A;306 Gq1 ajilliftrig
❑ ADDITION
Water Meter (Size—) Fee S —_
Meter#
Remote #
Municipal Water Connection Fee S —
❑Copper n
Municipal Sewer Connection Fee S _--
❑ Pw ❑ cast r-1-
MWCC SAC Charge
On Site Septic System
ACKNOWLEDGEMENT
Fee S_ _--
Fee S
The undersigned hereby acknowledges receipt of this Whited
permit, including acceptance of ad special information,
terms, conditions or requirements written above. The
undersigned understands and apses under penalty of law
t!at this permit is strictly limited in scope to the work.
activity or, improvement specified; that this Permit time
not pant my authority to do work or activities requhing
"pante Permit apprrwW: and that this Permit doer not
pant authority to violate my prorldon of my City
ordinance or State law, rule or regulation. Ali work shall be
done in street compliance with as city ordiame". budding
codes and/or health department regulations, and sball be
subject to inspection, approval or rejection by the City.
Whenever an ordered. the undersigned agrees to correct
my work found to be in violation of the conditions of
this perm".
Signature of Applicant
State License No.
❑ REPAIR
ater Well
anical Equipment
oving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
nkler System (Fire)
iter -the -fact Investigation
Nicoll n;11
State Surcharge:
Total Amount Paid to City
Fre
S
Fee
S
Fee
$
Fee
S
Fee S
Fee S
Fee S
Fee S
Fees p11,12)
Fee u. �
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
Cade: WhiteFileCopy Canary - Inspector's COPY Pink -Finance Copy Gold- Applicant's Receipt