HomeMy WebLinkAbout1986-05-28 Permit, Water Well #8487GENERAL PERMIT CITY PERMIT NO. 8487-
CITY OF ORONO g
Date
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner ✓ Address
Contractor O GL W-ell Address
City License No. ! State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Flum} ing (#fixtures_)
0 NEW ❑ ADDITION
Fee S
Water Meter (Size_) Fee S
Meter#
Remote #
Municipal Water Connection Fee S
❑ Copper r l ---
Municipal Sewer Connection Fee S _--
❑ Pv( ❑ Cast D
MWCC SAC Charge Fee S
On Site Septic System
ACKNOWLEDGEMENT
❑ REPAIR
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fire
Sprinkler System (Fire)
- (Other:
Fee S lAfter-the-fact Investigation
The undersigned hereby acknowledges receipt of this limited
permit. Including acceptance of W 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 Rant any authority to do work o, ctivities requiring
saparate permit approvals; and that No n rmit does not
Rant authority to violate any pro n of any City
xdinanee or State law, rule or regulation. All work shall be
done In strict compliance with all City ordinances, building
codes and/or health dcpartmonl regulations, 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 in violation of the conditions of
this permit.
Signature of Applic ant_
TOTAL
Fee S 1- 3v.67)
Fee S
Fee S
Fee S
Fee
S
Fee
S
Fee
S
Fee
S
State Surcharge: Fee S
Total Amount Paid to City Fee S 3o. -LZ�jl
This permit is not valid until the proper fee is paid and
it is approved by do authorized City Off. al.
Signature of City Official
Colr, Whitc File Copy Canar) - Inspector's Copy Pink - Finance Copy Gold —Applicant's Receipt