HomeMy WebLinkAbout1985-10-03 Permit, Water Well #8114GENERAL PERMIT
CITY OF ORONO
P.O.BOX66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
CITY PERMIT NO. 81l4
Date
Owner
Contractor
City License No.
0
ddress ^ ^
ddress
State License No.
tV\+^Q^
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: □ NEW □ ADDITION □ REPAIR
WeU
Mechanical Equipment
Moving ^Lifting Buildings
Inside Plumbing (#fixturcs __)Fee $
Water Meter (Size )Fee S
Meter#
Remote #
Municipal Water Connection Fee $
nCoDoer n
Municipal Sewer Connection Fee $
□ pVC Ocast n
MWee SAC Charge Fee $
On Site Septic System Fee $
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee
Fee $__________
Fee $__________
Fee $__________
Fire
Sprinkler System (Fire)
Other:_____________
After-the-fact kivestigation
Fee $.
Fee $.
Fee $
Fee S.
ACKNOWLEDGEMENT
Til* ttnilmliHR* hmby raedpt of ikIaBmItod
Bonait, taehidlBi aoM^teaeo of «0 portal intoimattoa,
toma. eoadMoM or raqulnmaata wdMon abova. Tba
•*oaanf«aod oadatataadi and a*oaa uadar paaaltr of law
tkol thia Mnlt la aMctb Itaillad fai aeopa to lha woak,
•etIvItT or iBpooaoaiaBt ^adHad; ttiat ttda pamlt doaa
not vaat aar aalMMltp to do wotk or actlvlttaa laquiilBg
aaparata panalt approaala: aad dut thla panalt doaa not
ffoat aadioiltr to dolato my paovlalon of aar aty
oadtaaaea or Stala law. mla or ragalatloa. AB arotk diaB ba
doaa la aMat aoaipllaaea with aB aty oidlaaaaaa, bulldlas
aodaa aad/or hoallb dapartaiaat tapidatloaa. wd diaB ba
aahlaat to laapaattoa. toProral or laloettoa by dia aty.
Wbaaaiai ao otdavad. Bm aadaaddaad agiaaa to eonaet
aay wotk foaad to ba la vlolatloa of tba eoadltloBa of
tblapaaalt.
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S.
Fee
This permit is not valid until the proper fee is paid and ^
it is approved by an authorized Qty Official.
Sigi^re of City Ofndal
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