HomeMy WebLinkAbout1985-08-02 Permit, New Water Well #8017GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(6 12) 473-7357
Owner h CIW6 Address
CITY PERMIT NO. 8017
Date _ V ^ 9
Co :tray :or ,/ �" i -C t.;l z� ��e, �I( IL -LL Address S
City License No.Z State License No.
REMARKS AND SPECIAL CONDITIONS /
PERMIT TYPE AND FEE
Inside Plumbing Ofixtures_)
Water Meter (Size_)
Meter#
Remote
1�J NEW ❑ ADDITION REPAIR
\ Fee S lWater Well
Fee S - - --_ IMechanical Equipment
Municipal Water Connection Fee S
❑Copper n
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast 0_
MWCC SAC Charge Fee S _ _
On Site Septic System
ACKNOWLEDGEMENT
Fee v -r i
Fee S
Moving !Lifting Buildings
Fee
S
Land Alteration (Excavation,
Grading. Filling, etc.)
Fee
S
Fire
Fee
S
Sprinkler System (Fire)
Dthel`:
Fee
Fee
S
S / S
Fee S (After -the -fart Investigation Fee S
The undersigned hereby acknowledMs receipt of this limited
Permit. Including acceptance of all special Information,
terms, conditions or requirements wdtten above. The
undersigned understands and agrees under penalty of law
that this permit is stricuy limited 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 asy provision of any City
ordinanceor State law, rule or regulation. Ali work shall be
done in strict compliance with all City ordinances, building
codes and/or 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 violation of the conditions of
this permit.
Signature of Applicann�tt
TOTAL
State Surcharge: Fee S - SZ)
Total Amount Paid to City Fee S 3---a oo
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signatu f City 7Offl(/,.fi
Code:White-FileCopy Canary --Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt