HomeMy WebLinkAbout1984-06-27 Permit, Water Well #7479GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
t _ , (612) 473-739&
Owner 1 ",/
Contractor
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FLT:
Inside Plumbing ( # fixtures )
NEW ❑ ADDITION
Fee $_
Watt:r Meter (Si/e ) Fee $
Meter It
Remote 1)
Municipal Water Connection Fee $
❑ Copper ❑
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast ❑
MWCC SAC Charge Fee $
ACKNOWLEDGEMENT
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 Limited in scope to the work,
activity or improvement specified: that this permit don
not grant any authority to do work or activities requiring
separate permit approvals: and that this permit does not
Rant 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 relection 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
CITY PERMIT NO. - 74191
Date
EV
Address (0 1 0 �--
Address a� /1
State License No.
❑ REPAIR
Or Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S
Fee $
Fee $
Fee $
Fee $
Other: Fee $
After -the -fact Investigation Fee $
TOTAL
State Surcharge: Fee $
Total Amount Paid to City Fee S 36• v v
This permit ', not valid until the proper fee is paid and
it is approved by an authorized City Official.
Sign • of City Official
�ti��Zl t
Code: White -I tic Copy Canary Inspector's Copy Pink -I inance Copy Gold --Applicant's Receipt