HomeMy WebLinkAbout1985-12-05 Permit, Water Well #8222GENERAL PERMIT CITY PERMIT NO. 8222
CITY OF ORONO
Date
P.O.BOX 66
CRYSTAL BAY. MINNESOTA 55323
(612) 473-7357 dc
1E f� �G�
Owner � � � Address v �
Contractor �Tf 11 ` Cr Address C'
City License No. ' �'� State L;_ense No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEC: M-A-h:W ❑ ADDITION ❑ REPAIR
Inside Plumbing (#fixtures_)
1-ce-
Fee
%%';Iter deter (Size_)
1 -cc
ti _
Meter#
S
Remote 1
Municipal Water Connection
Fee
S . --
❑Copper F1
Municipal Sewer C'onncction
Fee
S -- _
0 Pvc ❑ ca't n
MWCC SAC Charge
Fce
S .
On Site Septic System
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.I
-ire
Sprinkler System (Fire)
her:
Fee S lA.fter-the-tart Investigation
ACKNOWLEDGEMENT I TOTAL
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance ret all special InformsUon,
terms, condition or requirements written above. The
undemitned 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 ork or activities requiting
sep •He permit approvals. and tat this permit does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulaUon. Ali work shall be
dune In strict compliance with all City ordinances, building
codes and/or health department regulaUons, and shall be
subject to Inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agrees to correct
anv work found to be in violation of the conditions or
this permit.
SignaturC of ApphL:ant
( ,ode %hilc I de Cops Canary In%Mtor's Cop)
Fee
S
Fee
S
Fee
$
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
State Surcharge: Fee S
Total Amount Paid to City Fee
This pemlit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
i
Pink I iname Copy Gold Applicant's Receipt