HomeMy WebLinkAbout1983-07-13 Permit, Water Well #7068GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner &AoV I Ur I
F,-, r—,T— —
Contractor �3
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE. AND FEE: *NEW ❑ ADDITION
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter # _
Remote #
Fee S
Fee S
Municipal Water Connection Fee S
❑ Copper rl
Municipal Sewer Connection Fee S
❑ PVC' ❑ Cast
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee S _
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information•
terias, 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 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 Applican�
CITY PERMIT NO. 706 I
Date T,3
Address / J
!E� 4j',ke_�
Address
State License No,
❑ REPAIR
On Site Septic System Fee S �,,
Water Well Fee S ao. o0
Mechanical Equipment Fee S
Moving/Lifting Buildings Fee S
Land Alteration (Excavation, Fee S
Grading, Filling, etc.)
Other:_ Fee S
After -the -fact Investigation Fee S
DOTAL
State Surcharge: Fee S
Total Amount Paid to City Fee S e• S
This permit is ;lot valid until the proper tcc is paid and
it is approved by an authorized City Official.
Sig ! of( Its Official
Code White File Copy ('anarf hupech,r's ('opy Pink I finance Cop) Gold Applicant's Receipt