HomeMy WebLinkAbout1983-05-05 Permit, Repair Water Well #6982GENERAL PERMIT CITY PERMIT No. _-69821
CITY OF ORONO
P.O.BOX 66 Date
CRYSTAL HAY, MINNESOTA 55323
(612) 473-7357 Owner �Ay _ JO1p1Anro, Address -/ Q
m 1)AK-43TJ% Av E
Contractor ,1 \i7 O LA \J,)U �- Address MTK& l M%y\n
City License No
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
State License No
❑ NEW ❑ ADDITION AREPAIR
Inside Plumbing( M fixtures ) Fee S I On Site Septic System
Water Meter (Size )
Meter #
Remote #
Fee S
Municipal Water Connection Fee S
❑Copper n
Municipal Sewer Connection Fee S
❑ PVC ❑ cast n
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee S
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of W sjeetal information,
terms, conditions or requiremenla written above. The
undersigned understands and agrees under penalty of law
that " permit is strictly United in scope to the work,
activity of improvement specified; that this permit does
not grant any authority to do wort 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 re regulation. AU work shall be
done in strict compliance with all City ordinances, building
codes and/or health department regulaUoaa, 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 to violation of the conditions of
Nis permit.
Signature of Applicant
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:
After -the -fact Investigation
TOTAL
Fee
S
Fee
S .101 06
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
State Surcharge: Fee S 2 0'
Total Amount Paid to City Fee S
This permit is not valid until the proper tee is paid anti
it is approved by an authorized City Official.
Signatupy o
v
Code White - File Copy Canary Inspeca.r's Copy Pink I mance Copy Gold Applicant's Receipt