HomeMy WebLinkAbout1986-06-23 Permit, New Water Well #8538GENERAL PERMIT CITY PERMIT NO. 8538
CITY OF ORONO
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
01612C
Owner Pit Address / C ell �.
Contractor Address, IV
AJI
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
NEW ❑ ADDITION
Fee S
Water Met,-r (Size) Fee S
Metes M
Remote
Municipal Water Connection Fee S
[]Copper
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast Q
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)
er:
Fee S IAfter-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
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 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 Clty ordinances, building
codas an
health department regulations, and shall be
subkct to Inspection, approval or refection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in �iolatlon of the conditions of
this permit
Signature of Applicant
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 f
Fee S 3�•
This hermit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Offi 'al
14M
Code White- Pile Copy Canary Inspector's Copy Pink -Finance Copy Gold Applicant's Receipt