HomeMy WebLinkAbout1981-12-22 Permit, Water Well #6602GENERAL PERMIT CITY PERMIT NO. — 6602
CITY OF ORONO
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357�Q n
Owner i ,kZ3Q�Ue,,0'7 ,L�a,�ft�rs _ Address
Contractor & 02jw Address
City License No. State License No.
REMARKS AN' "PECIAL CONDITIONS
PERMIT TYPE AND FEE: ( NEW
Inside Plumbing ( # fixtures , ))
Water Meter (Size )
Meter #
Remote #
❑ ADDITION
Fee $
Fee S
Municipal Water Connection Fee $
❑Copper rl
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast n
MWCC SAC Charge
ACKNOWLEDGEMENT
G REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other:
Fee $ I After -the -fact Investigation
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions or requirements written above. The
undesirned understands and agrees under penalty of law
that " permit is strictly Whited in scope to the work,
activity or improvement specifted: that this permit does
not grant any authority to do work or activities requiring
separate permit 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 shall be
done in strict compliance with all City ordinances, building
codes %nd/or health department regulations, and shall be
sublect 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.
SignatureAf Applicant
TOTAL
Fee S
Fee $ _s:IL.LC
Fee $
Fee $
Fee $
Fee S
Fee S
State Surcharge: Fee S
Total Amoun; Paid to City Fee S S�
This permit is not valid until the proper fee is paid and
it is appr•-)ved by an au.;iorized City Official.
Signature of City Official
Cude: White -File Copy Canary—Intpector's Copy Pink —Finance Copy Gold- ApplicPn'.'s Receipt