HomeMy WebLinkAbout1984-11-20 Permit, Water Well #7724GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 7724
Date /- '-ve) —�7
O%tiner_i���1e^�r1�`�l�l"1 ll Address�
Contractor +-0do ��I � ��J�. > Address e % %
City License No. 7 State License No.
R, `BARKS AND SPECIAL CONDITIONS
&o /GCS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
Water Meter (Size—)
Meter#
Remote -1
❑ NEW ❑ ADDITION
Fee S
i-ee S
Municipal Water Conner tiun Fee
❑Copper (—
Municipal Sewer Connection Fee S —
❑ PVC ❑ Cast El
MWCC SAC Charge F >
On Site Septic System
ACKNOWLEDGEMENT
❑ REPAIR
ater Well
Mechanical Equipment
/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fire
Fee S
Fee S
Fee S
Fee S
Fee S i
kler System (Fire) Fee S
Fee S
Fee S lAfter-the-fact Investigation 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 agues under penalty of law
that this permit is strictly Ilmited In scope to the work,
activity or improvement specihrt . that this permit does
not Brant any authority to do work or activities requiring
separate permit approvals; and that this permit does not
grant authority to violate any provision of an City
ordinance or State law, rule or regulation. All work shall be
done In strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subject to inspection, approval or rejection by the City.
Whenever so ordere 1. the undersigned agrees to correct
any work found t., be in %iolation of the conditions of
this permit.
Signat re 'Ap icant
loc-L
TOTAL
State Surcharge:
Fee S — -S-0
Total Amount Paid to City Fee $'0-
This permit is not valid until the proper fee is paid ai
it is approved by an authorized City Official.
Signature of City
Code: White --File Copy Canary —Inspector's Copy Pink —Finance Copy Gold—Appik-ant's Receipt