HomeMy WebLinkAbout1986-01-28 Permit, Water Well #8319CITY PERMIT NO. 8319,
GENERAL PERMIT
CITY OF ORONO t c
P.O.BOX 66 Date_
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner 1 Cn. AC- Address a5?Ct)
Contractor Address > a C<_)
City License No. IS__7 State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: 4I NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing (#fixtures_) Fee S
Water Meter (Size_)
Meter#
Remote
Municipal Water Connection
❑Copper n_
Municipal Sewer Connection
❑ PVC ❑ Cast
MWCC SAC Charge
On Site Septic System
ACKNOWLEDGEMENT
Fee S____
_
Fee S ------
Fee S _ -
n
Fee S _
Fee S
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of sill special :nforrnation,
terms, conditions or requirements wdtten above. The
undersigned understands and agrees under penalty of law
V,..at thls permit is strictly limited In scope to the work,
activity or Improvement specified; that this permit does
not grant .sty 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 and/or health department regulations, and shall be
subK-t to Inspection, approval or rejection by the City.
Whet.• cr so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signature of Applicant
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fire - _
Sprinkler System (Fire)
Other:
After -the -fact Investigation
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee S
Fee S
Fee S
Fee
S
Fee
S
Fee
S
Fee
S
Fee S ' 50
so
Fee S��t
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
j
Code. Wh c File Copy Canary -Inspector's Copy Pink -Finance Copy Gold - Applicant's Receipt