HomeMy WebLinkAbout1985-12-04 Permit, New Water Well #8221Y
GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
3 CRYSTAL BAY, MINNESOTA 55323
(E 12) 473-7357
CITY PERMIT NO. 8221
Date f `t r ��
Owner Address __ Otc—Lpj L L i
Contractor d I J21 `��iy�VC' `� IN P4 Address 1 WL i
111)
City License "o. � l7� State License No. I
REMAhxS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (Mixtures_)
Water Meter (Size _)
Meter#
Remote
❑ NEW ❑ ADDITION ❑ REPAIR
Fee S Water Well
Fee S.----- Mechanical Equipment
(Moving /Lifting Buildings
Municipal Water Connection Fee S —_
❑Copper n _
Municipal Sewer Connection Fee S _—
❑ PVC ❑ Cast
M WC C SAC Charge Fee S —
On Site Septic System
ACKNOWLEDGEMENT
Fee S
The undersigned hereby acknowiedp receipt of tbla umlted
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 sc Ppe to the work,
activity or iriprovement 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 regulctlon. All work &hall be
done in strict compliance with all City ordinances building
_ (Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S
Fee S
Fee S
Fet: S
Fire _ Fee S I
f,rinNer System (Fire)
Fee S
her: Fee $f
er-the-fact 11-vestigation Fee S
TOTAL
State Surchar.e.
Total Amount Paid to City
Fee S
Fee S smolt_
codes and/or health department regulations, and shall be This permit is not valid until the proper fee is paid and '
subject to inspection, approval or rejection by the City. it is approved by an authorized City Official
Whenever so ordered, the undersigned &act& to correct
any wotk found to be in %iolation of the cu ditions of
this permit. I
i
Signature of Applicant Signature giCity Official 1
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Code. White - File Copy Canary--lnspectot's Copy Pink -Finance Copy Gold -Applicant's Receipt