HomeMy WebLinkAbout1985-08-13 Permit, Water Well #8034GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473.7357
CITY PERMIT NO. 8034
Date e' e / v
Owner &L, nazia Address
Contractor �[ r�0[7 WWI Ot)To t J Address
City License No. c 7 L State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (Mixtures_)
Water Meter (Size—)
Meter#/
Remote
NEW ❑ ADDITION
Fee S
Fee S
Municipal Water Connection Fee S
❑Copper F1
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast n
MWCC SAC Charge Fee S
On Site Septic System Fee S
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 does
not grant any authority to do work or activities requiring
separate permit approvals; and that this permit does not
grant wthority to violate any provision of any City
ordinance or State law, Wile or regulation. Ali work shall be
done in rfrtet 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 agree to correct
any work found to be in violation of the conditions of
this permit.
Signature of Applicant
ti � kJ
❑ REPAIR
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fire
Sprinkler System (Fire)
Other:
After -the -fact Investigation
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S 2 n 00
Fee S
Fee S
Fee $
Fee
$
Fee
S
Fee
S
Fee
S
Fee S '
Fee S�
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Offici �6P
Code: White —File Copy Canary - Inspector's Copy Pink —Finance Copy Gold —Appticant's Receipt