HomeMy WebLinkAbout1986-06-24 Permit, New Water Well #8539GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-735`7
Own_r// L ZC <- 1� Address
Contractor ` `-'' ��� Address
City License No. _ r State Lig
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
CITY PERMIT NO. 8539
Date
e
❑ NEW ❑ ADDITION ❑ REPAIR
Fee S
Water Meter (Size_) Fee S
Meter#
Remotel,
Municipal Water Connection Fee S
❑Copper ri
Municipal Sewer Connection
❑ PVC ❑ Cast
MWCC SAC Charge
On Site Septic System
ACKNOWLEDGEMENT
Water Well
-- Mechanical Equipment
Moving /Lifting Buildi
Land Alteration (Exca
Grading. Filling, etc
Fee S -- --
a-
Fee S
re
nkler System (Fire)
Fee S After -the -fact Investigation
The undersigned hereby acknowledges receipt of" limited
permit. including acceptance of di 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 don
not grant any autkodty to do work or activities requiring
separate permit approvals: and that this permit don not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. AS work shall be
done in strict compliance with all City ordb mcm. building
codes and/or health department regulations, and sball be
subject to inspection, approval or rejection bs the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this peewit
Signa re of pplicant
TOTAL
State Surcharge:
Fee S �'"•yr�
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Total Amount Paid to City
Fee
Fee
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Code: White —I -Ile Copy Canary—inspector's Copy fink—Finance Copy Gold—AppNeaat's Rtiosipt
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