HomeMy WebLinkAbout1985-05-02 Permit, New Water Well #7896GENERAL PERMIT CITY PERMIT NO. 7896
CITY OF ORONO
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(o 12) 473-7357
Owner Address S i < C_GG.ICJ
Contractor 1/5+'Yt S
— QS Address 1�5
City License No. y#__ /t A State License No.
REMARKS AND SPECIAL. CONDITIONS
PERMIT TYPE AND FL;
Inside Plumbing (Mixtures_)
Water Meter (Size—)
Meter#
Remote #
Pq NEW Cl ADDITION
❑ REPAIR
Fee S Water Well
Fee S —__— _ _ _ Mechanical Equipment
Municipal Water Connection Fee S _
[]Copper ❑
Municipal Sewer Connection Fee S —
❑ PVC ❑ Cast r—
MWCC SAC Charge Fee S —_
On Site Septic System
ACKNOWLEDGEMENT
oving /1 "'• q Buildings
ILard Alteidtion (Excavation,
Grading, Filling, etc.)
ire
prinkler System (Fire)
tiler:
Fee S IAfter-the-fart Investigation
The undersigned hereby acknowledges receipt of this limited
Permit, including acceptance of all special information,
terms, conditions or requirements • ritten above. The
undersigned tuAerstands and agrees under penalty of law
th.t this permit is strictly limited in scope to the work,
activity or improvement ,p*cified: that this permit does
not grant any authority to do work or activities repuir.ug
separate permit approvals; and that this permit does not
grant authority to violate any i rovision of any City
ordinance or State taw, rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
codes midlor health department regulations, and shall be
sublect to inspection, approval or rel•eetion by the City.
Wbenever so ordered, the unA--signed agrees to correct
any work found to be in .,elation of the conditions of
this permit.
Signature of Applicant
TOTAL
Fee Scgro . edr
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
$
Fee
S
State Surcharge: Fee S_ '
Total Amount Paid to City Fee
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature f Cit}• Offi I
a _J
Code White Idle ('op),
Canary - Inspector's Copy
Pink -Finance 0K gold -Applicant's Receipt