HomeMy WebLinkAbout1983-07-11 Permit, New Water Well #7064GENERAL PERMIT CITY PERMIT NO. --'7064
CITY OF OR0.T 0 -�-1/_,�3
P.O.BOX act Darr
CRN S I AL. BAY, MINNESOTA 55323
(61 _') 473-7357
/ /
Ot+ner %�� � � `
Address � �-n oz), _
Contractor XQ/ &-z4wress 1,31& L-) _
City License No. _---._.--- -- State Liccww No. --_-- _--
Rl MARKS AND SPI-CIAL CONDITIONS
PERMIT TYPE AND FEE: 0,NEW ❑ ADDITION
ln,.ille Plumbing ( # fixtures )
Water Meter (Size )
Meter #
Remote #
Municipal Nater Connection
El Copper Q
Fee S
Fee S
Fee S
Municipal Scwcl- Connection Fee S
❑ PVC' ❑ Cast Q — --- - —
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee S
Thr undersigned hereby d%knuwledg— receipt of this limited
permit. including acceptance of all special inform.tion.
terms, nonditions or requiremrims written above. 'rh,
undersigned understands and agrees under penalo of law
that this permit Is strictly limited in stupe to thc wurk.
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
Rant authority to violate any Provision of any t it%
ordinance or State law, rule or regulation. Aa work shall bo -
done In strict compliance with all Cidin
ty ordinances, building
codes and/or health department regulations, and shall bo-
subject
esubject to inspe.tion. approval or mlection by the Cit%
Whenever so ordered, the underaigned agrees to torr- t
any work lound to be its %iolatlon of the cunditlons of
this p,rrmt
S a re o oft: axil
1
ILL,
❑ REPAIR
Oil Site Sepik systelll
Water well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
I-ce
S
Fee
S -c"
Fcc
S
Fee
S
Fee
S
Other: Fee S
After -the -fact Ime.tigatit>n Fee S
TOTAL
State Surcharge: Fee S • J �� l
Total Amount Paid to City Fee �
This pennit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Sign't e o1 t It\ OI ficial
�Q
it's Cupy Pink 1 inane Copy Gold Applicant's Receipt