HomeMy WebLinkAbout1983-08-30 Permit, New Water Well #7126GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PF.RMIT NO. 7126 ,
Date 3C — 3
Owner, hlixizZ0 1 L1 J�e�SC�� Q,�;t,� _ \ Cj`^C-.5%ddress _ 7&00 3Ajc=-VAe—
Contrartor�l � _---_--------- Address
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FI::E::
Inside Plumbing ( # fixtures
�NEW ❑ ADDITION
Fee $
Water Meter (Size ) Fee $
Meter # _
Remote #
Municipal Water Connection Fee S
❑Copper
Municipal Sewer Connection Fee S
❑ PVC ❑ cast 0-_
MWCCSAC Charge
ACKNOWLEDGEMENT
Fee $
The undersigned hereby acknowledges receipt of this limited
permit. Including acceptance of all special information,
terms, cor.ditions or requirements written above. The
undersigned understands and agrees under penalty of law
the# ::ds permit is strictly 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 any provision of any 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 shall be
subJect to Inspection, approval or relectlon 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 Applicant
T
❑ REPAIR
On Site Septic System Fee S
Water Well Fee S
Mechanical Equipment Fee $
Moving/Lifting Buildings Fee $
Land Alteration (Excavation, Fee S
Grading. Filling, etc.)
Other: Fee S
After -the -fact Investigation Fee $
ZU 10 O
.TOTAL
State Surcharge: Fee 5
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.
Signatt of city Of
Code: %'hile — mile Copy Canary --Inspector's Coay Oink -Finance Copy Gold AppliLant's Receipt