HomeMy WebLinkAbout1982-01-13 Permit, New Water Well #6613GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner
0
Id
Address
Contractor WALL. Address
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: gNEW ❑ ADDITION
Inside Plumbing ( # fixtures )
IN dter Meter (Size )
Meter #
Remote #
Municipal Water Connection
❑ Copper Q
Municipal Sewer Connection
❑ PVC ❑ Cast El
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee $
Fee $
Fee $
Fee $
Fee $
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 pant any authority to do work or activities requiting
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 speer to correct
any work found to be in violation of the conditions of
this permit.
re of Appli nit
CITY PERMIT NO. 66191
Date I — 13 —
P 7 -
State License No.
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Yh
Fee $
Fee $ c2D . ori
Fee $
Fee $
Fee $
Other: Fee $
After -the -fact Investigation
TOTAL
State Surcharge:
Fee $
Fee $ A �rO
Total Amount Paid to City Fee $ c� V —
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
of City O
Code: White - File Copy Canary —Inspector's Copy Pink—Finance Copy Gold Applicant's Receipt