HomeMy WebLinkAbout1984-07-24 Permit, Water Well #7532GENERAL PERMIT CITY PERMIT NO. _. 7532,
CITY OF ORONO ?—)4-
P-O-BOX 66 Date — —a
CRYSTAL BAY, MINNESOTA 55323
- (612) 473-73W
Owner CA -A a
Address
Contractor Ae"�iezP
( dress l
City License No.4ate License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: NEW ❑ ADDITION
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter # _
Remote M
Fee S
Fee $
Municipal Water Connection Fee S
❑Copper El
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast Q_
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee S
The undersigned hereby acknowledges receipt of this umlted
Parrott, including acceptance of all special information,
taros, conditions or requirements written above. The
undersigned understands and saren under Penalty of law
that this Permit is strictly limited to scope to the work,
activity of improvement specified: that this Permit don
not Rant any authority to do work or activities requiring
ro separate Pefil approvals: and that this Permit don not
Rant authority to violate any provision of any City
oedlnance or State law, rule or regulation. Ali work shall be
done in strict compliance with all City ordinances, building
codas and/or health department regulations, and shay be
subject to Inspection, approval of relection 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 Applicant
C01
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S
Fee S 3D. 5o
Fee S
Fee S
Fee S
Other: Fee S
After -the -fact Investigation Fee S
TOTAL
State Surcharge:
Total Amount Paid to City
Fee
Fee
S�
S 30.50
This pem)it is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Si a of Official;
_EW / _I i A.
Code White - Pik Copy Canary Inspecior's Copy Pink finance Cop) Gold Applicant's Receipt