HomeMy WebLinkAbout1985-10-30 Permit, New Water Well #8154GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(6 12) 473-735
Owner
Contras
City Li
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: "71!iNEW
Inside Plumbing (#fixtures_) Fee S
Water Meter (Size—) Fee S
Meter#
Remote -1
CITY PERMIT NO. 8154
Date / U - k3U'
Address c�
Address RE 1 /;nX17Sr JCa�,
Mate License No,
❑ ADDITION ❑ REPAIR
Municipal Water Connection Fee S
❑Copper ❑
Municipal Sewer Connection Fee S _--- .
❑ PVC ❑ Cast r-
MWCC SAC Charge Fee S
On Site Septic System Fee S
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of thle limited
permit. Including acceptance of as 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 We work.
activity or improvement spsalfled: that this permit does
not grant any authority to do work or activities rotuldne
separate permit approvals; and that " penult does not
grant authority to violate any provision of my 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 regulations, and shell be
subject to Inspection, approval or rejection by elle City.
Whenever so ordered, the undersigned agrees to correct
any work found to be In violation of the conditions of
this permit.
Signature of Applicant
i6u4i,•_ AL,
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S O' Q
Fee S
Fee S
Fee S—
ire
Fee
S
.)rinkler System (Fire)
Fee
S
ther:
Fee
S
fter-the-fact Investigation
Fee
S
TOTAL
State Surcharge: Fee S
Total Amount Paid to City Fee
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signatur City
Code: White - File Copy Canary --Inspector's Copy Pink—Finance Copy Gold—AppUcagt's Receipt