HomeMy WebLinkAbout1982-05-24 Permit, New Water Well #6692GENERAL PERMIT
CITY OF ORONO
Owner
Contrac
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(613) 473-7357
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 Q
MWCC SAC Charge
ACKNOWLEDGEMENT
❑ ADDITION
Fee $
Fee $
Fee $
Fee $
Fee S.
The undersigned hereby acknowledges receipt of this limited
Permit, including acceptance of all special Information,
term^ 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 W do work or activities requiring
separate permit approvals; and that this permit does not
Want 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
aril, work found to be in violation of the conditions of
Address
Address
CITY PERMIT NO. 66921
Date �� —e
State License No.
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:
After -the -fact Investigation
TOTAL
State Surcharge:
Total Amount Paid to City
Fee $
Fee $
Fee $
Fee $
Fee $
Fee $
Fee $
Fee $ S"61
Fee $ C_ r_ . Sa
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signatjlre of City Offic
rf2
Code White I tic Copy Canary Inspector's Copy Pink - Finance Copy Gold Applicant's Receipt