HomeMy WebLinkAbout1984-12-11 Permit, New Water Well #7748GENERAL PERMIT
CITY OF ORONO
CITY PERMIT NO.7748
P.O.BOX 66
CRYSTAL BAY. MINNESOTA 55323
612)475-7357
Date
Owner____
Contractor«
City License No._______________
Address
Address
:>CA'U..
/.r Mvy -7- .
State License No.
RL.MARKS AND SPECIAL CONDITIONS
PERMIT TYPE AN DELE:
Inside Plumbing (jlit'ixtures__)
□ ADDITION □ REPAIR
Water Meter (Si/e
Meter# ___
)
I ee S
l*ee S
Remote #
Municipal Water Connection
CDCopper n
Lee S
Municipal Sewer Connection
□ PVC □ Cast Q
MWCC SAC Charge
On Site Septic System
Lee S —
Lee S_____
Fee S_____
Water Well
Mechanical E(|uipment
Moving / Lilting Buildings
Fee S JDm
Land Alteration (Excavation.
Grading. Filling, etc.)
Fee $
Fee $
Fee S
Fire
Sprinkler System (Fire!
Other;______________
After-the-fact Investigation
Fee S
Fee S
Fee S
Fee S
ACKNOWLEDGEMENT
The undersifned 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 dues
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 regulatioru. and shaU be
subiect to inspection, approval or relection by the City.
Whenev*er so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
thu permit.
Signature of Applicant
TOTAL
State Surcharge:Fee S SO
Total Amount Paid to City Fee $
This permit is not valid until the proper fee is paid and
it is approved by an autliori/-ed City Official.
c
Sigpdfu)|6 of City Official -
('ode N^hitc I ilc Cop)Canar>' Inspector’s Cop>Pink I in ante C'op>(fold Applicant’s Recapt