HomeMy WebLinkAbout1985-12-04 Permit, Water Well #8220GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner
Contractor <L> ,r1
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#fixtures_)
Water Meter (Size—)
Meter#
Remote
❑ NEW ❑ ADDITION
Fee S
Fee S —._ .
Municipal Water Connection Fee
❑Copper Q
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast n
MWCC SAC Charge Fee S
On Site Septic System
ACKNOWLEDGEMENT
CITY PERMIT NO. 8220
Date
Address _
Address
State License No.
❑ REPAIR
(Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fire
Sprinkler System (Fire)
her:
Fee S (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
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 Is-, 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
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 Applicant
TOTAL
Fee S
Fee S
Fee S
Fee S
Fee
S,_
Fee
S
Fee
S
Fee
S
State Surcharge: Fee S_�)n
Total Amount Paid to City Fee S_
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
Code White -File Copy CAnar) Inspector's Copy Pink -Finance Copy Gold —Applicant's Receipt