HomeMy WebLinkAbout1982-08-03 Permit, New Water Well #6759GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner— 411,1jIlta, //,,d
Contractor— el�� 111,11
City license No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: NEW
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter #
Remote #
❑ ADDITION
Fee $_
Fee $
Municipal Water Connection Fee $
❑Copper rl
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.
terns, conditions or requirements written above. The
undertgned 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
gent authority to violate any provision of any City
ordinance or 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.
Sign of Applicant
�t.�
CITY PERMIT NO._ 67591
Date
Address C/ /
Address �0�4�(7 A�
State License No.
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:
After -the -fact Investigation
TOTAL
Fee
S
Fee
S
Fee
S
Fee
$
Fee
$
Fee
S
Fee
$
State Surcharge: Fee S"
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.
Sign' r of City Official 1
Code: White —file Copy
Canary --inspector's Copy
Pink —Finance Copy
Gold Applicant's Receipt