HomeMy WebLinkAbout1987-07-01 Permit, Water Well #9090Owner
Contractor
GENERAL PERMIT
CITY OF ORONO
P.O. BOX 66
CRYSTAL BAY, MINNESOTA 55323
_ (6>?) 473-7357
CITY PERMIT N9 9090
7-/-g'7Date
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Address
Address
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City License No. "" <?0 ^ ^ y (jQ^I/ "^ V^City /^C(LJC Ps.^ _______
REMARKS AND SPECIAL CONDITIONS
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PERMIT TYPE AND FEE;
Inside Plumbing (^fixtures _
Witer Meter (Size___)
Meter#__________
Remote #
Municipal Witer Connection
□ CoRjer □ ____
Fee $
Municipal Sewer Connection
□ PVC □ ast □
MWCC SAC Charge
On Site Spetic System
□ ADDITION □ REPAIR
\^^terWen
Mechanical Equipment
Fireplace/>\bod Stove
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading. Filling, etc.)
Design Review
Rre_________________
□ REMODEL
FeeS^^
Fee $
Fee $
P-e S
Fee $
Fee $72.^
ACKNOWLEDGEMENT
The undcrapird heirt*) ackiHmlnlge^ mwpi ihn limilnl pnmii.
indulinfi aoxfOiKT of all mmal inl<innauon. irnm. cnniitiom <»
miiarnncnn »niirn ahovr Thf undrr«tmcd undcr^andt and apr<*
under pmaliv if la>» ihai ih» prrmil w ^iniily limttnl in <iu>pc to ihr «»orfc
activity or imprmrmerM sfccified: (hat ih» permit d<*i not ^nni any
aulhnniy to do work or activturi fnjuinnf vparaic permit approvals, and
that dmprntuKkiesniafianiaulhmiy loviritetrany provisuvi of anv (it\
nrdinafiLT or State bw. rule <w irfulatKin All work shall he dorr in stncl
compfancr wnh aD Citv orUmancev huldiiv uaks and la hcakh
depanment itfulatianv. and shall he suhiect to tnvpectum. approval or
iryn-iHai hy the Citv WlrtTvet so onJered. the underv|inrd apres to
oormi any work found to he in vmlauon of the conhiions of this permit
Signature of Applicant
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'A IT./(
A
Sprinkler System (Rre)
Other ___________
After-the-fact Investigation
Fcf \
Fee $
Fee S
Fee S
Fee $
Fee S
TOTAL
State Surcharge;
Total Amount Riid to City
Fee $ /
Fee S //)6e t?Z)
This permit is not valid until the proper fee is paid and it is approved
by an authorized City Official.
S^naturpoT City OfBdal
Codf Whir tile Copy Canary Inspcvior's Copy Pink Finance C«'»py GoU Appiicaat's iteoe^M