HomeMy WebLinkAbout1983-12-16 Permit, Repair Water Well #7270GENERAL PERMIT CITY PIRMITNO.=-7270�
CITY OF ORONO
I O. BOX 06
C RYS I'AL BAY, MINNESOTA 55323
1612) 73-7?57
Owner V.-co Address
Contractor �e`1 _�-� � Address
State License No
RLMARKS AND SPECIAL CONDITIONS
fit RMI t 1 YP1 AN1) 1 1 I:: *NF4C ❑ ADDITION
Inside Plumbing 1 # fixtures f FCC S
Water Meter ISize 1
Meter
Remote
Fee S
Municipal Water Connection Fee S
❑ Copper ❑ --
Municipal Sewer Connection
^g Fee S
❑ PVC ❑ Cast r-1 _
MWCC SAC Charge
ACKNOWLEDGLMENT
Fee S
The unde-signed hereby acknowledges receipt of this limited
permit, including acceptarSce of all special information,
terms, cundittotis or requirements written above. The
undersigned 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 does
not pant ariv authority to do work or activities requiring
separate pernut rpprovals: and that this permit does not
pant authority to violate any provision of any City
ordinance or State law, rule or regulation. All work shall be
done in strict compliance with as City ordinances, building
codes and/or health department regulations, and shall be
subject to inspection, approval or rejection by the City.
Whenever sit ordered, the undersigned agrees to correct
any work found to be in .lulation of the conditions of
this permit.
Signature of' Applicant
A r�. uv-�-
XLW PA
On Sitc SChti, S%"Icill
Water N'Cll
Mechanical Equipment
Moving/Lifting: Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
FCC S
FCC S :;2-0,CZ
Fee S
Fee S
Fee S
Other: Fee S
After -the -fact Investigation Fee S
TOTAL
State Surcharge: Fee S _2 `•'
Total Amount Paid to City Fee S oC�/ . S0
This pennit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Swi t re of City Official
Code: Whitc--I ile Copy Canary Inspector's Copy
fink I mane (upy (—ld Applicant's Receipt