HomeMy WebLinkAbout1985-02-22 Permit, Replace Water Well #6952GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner----------------------------------------------------------
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City License No_______________________________
1.— - - —
Address
CITY PHRMIT NO. ” 6952
Date jFj?. /?r"
REMARKS AND SPECIAL CONDITIONS
State License No__
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PERMIT TYPE AND FEE:
Inside Plumbing ( # fixtures.
Water Meter (Size____)
Meter #___________
□ NEW □ ADDITION □ REPAIR
77
)Fee $.
Fee $.
Remote #
Municipal Water Connection
n Copper n
Fee $.
Municipal Sewer Connection
□ PVC □ Cast Q
Fee $.
MWCC SAC Charge Fee $.
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:.
After-the-fact Investigation
Fee S.
Fee
Fee S_ _ _
Fee $_ _ _
Fee S_ _ _
Fee $
Fee $
ACKNOWLEDGEMENT
The undcniinecl hereby eckuowledges receipt of Uiie limited
permit, including acceptance of all vecial information,
terma, condittons or requlromente written above. The
underMgnad undaratanda and agreea under penalty of law
that thia permit ia atiletly limited In aeope to the work,
acUvity or improvement apecifled: that thia permit doea
not grant any authority to do work or aetivttiea requiring
aeparate permit approvaia: and that thia permit doea not
grant authority to violate any proviaion of any City
ordinance or State law, rule or regulation. All woric ahall be
done in atrict compliance with all City ordinancea, building
codea and/or health department rcguiatlona, and ahall be
BUbiect to Inapection, approval or rejection by the City.
Whenever ao ordered, the imdenigned agreea to correct
any work found to be in violation of the condltiona of
thia permit.
Sigm^^^f Applicant
TOTAL
State Surcharge:
Total Amount Paid to City
Fee $
Fee S.
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of
Code: White-FUe Copy Canary - Inspector’s Copy Pink - I inance Copy Cold - Applicant’s Receipt