HomeMy WebLinkAbout1983-06-24 Permit, New Water Well #7040:NERAL PERMIT CITY PERMIT No. _70401
PITY OF ORONO
P.O.BOX 66 Date
CRYSTAL BA:', MINNESOTA 55323
(61-I) A73-7357
If 107 1.1111
Adders
SS
actor Address
License No. _ State License No. ,
MARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEF.:
Inside Plumbing ( # fixtures
Water Meter (Size )
Meter #
Remote #
❑ AUDITION ❑REPAIR
Fee $
Fee S
Municipal Water Connection Fee S
❑Copper
Municipal Sewer Connection Fee $ _
❑ PVC ❑ Cast n —
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee S
The undersigned 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 tlmtited in scope to the work,
activity or improvement specified: that this permit does
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 W City ordinances, building
codes andlor health department regulations, and shall be
subject to inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in %iolation of the conditions of
/bis permit.
Signature of Applicant
. 6�4=
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excalation,
Grading, Filling, etc.)
Fee S �A
Fee S
Fee S
Fee S
Fee S
Other: Fee S
After -the -tact Investigation Fee S
TOTAL
Stats' Surcharge Fee S
Total Amount Paid to City Fee S
This pennit is not valid until the proper tee is paid and
it is approved by an authorized City Official.
'd,
Code While I ile Copy Canary Inspector's Copy fink I inance Copy Gold Applicant's Receipt
IN
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