HomeMy WebLinkAbout1983-12-06 Permit, Water Well #7264GENERAL PERMIT
CITY OF ORONO
P.O.BOx 66
CRYSTAL BAY, MINNESOTA 55323
(61 _') 473-735
CITY I+RMIT NO. 72641
Date 12-6 - ?**�
Owner _ _ l OM J�E-'/-Z Address 1-115,— "C/ VLC-
Contractor —6" S`rCyo COLA (/Oe-LCL Address M-715 4
City License No,
REMARKS AND SPECIAL CONDITIONS
State License No.
i!oiP Y o F S 7-i i!,j L IC e_r, i�_L� m r y
PERMIT TYPE AND FI-F.: 9NFW
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter 4 _
Remote #
❑ ADDITION
Fee $
Fee S
Municipal Water Connection Fee S
❑ Copper E..
Municipal Se%kvr Connection Fee S
❑ PVC' ❑ cast Q
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee S
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 wthority to do work or ectivtUes requiring
separate perm approvals; and that this permit does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. All work shail be
done in strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subject to inspection, approval or re►ecUon by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be of violation of the conditions of
this permit.
Signature ol' Applicant
( udc 'Ahite I de ropy
❑ 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
1=ee
$
Fee
$
Fee
S
Fee
S
Fee
S
Fee
S
State Surcharge' Fee S S01
Total Amount Paid to Cit. Fee S --'
This pennit is not valid until the proper tee is paid and
it is approved by ar •uthorized City Official.
Signature of Cjty Officia
Canary Inspector's Copy Pink I inance C'op� (,oid Applicant's Receipt