HomeMy WebLinkAbout1985-06-20 Permit, Water Well #7961GENERAL PERMIT CITY PERMIT NO. 7961
CITY OF ORONO -A0 s�
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55.323
(612) 473-7357
Owner�4 ddress -**')J()
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2
Contractor t Bla "� Address
City License Nn. State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FL!:: ❑ NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing (#fixtures_.) Fee S
Water Ds ter (Size—) Fee S
Meter #
Remote #
Municipal Water Connection Fee S —
❑Copper Q
Municipal S. wer Connection Fee S —
❑ PVC ❑ Cast
MWCC SAC Charge
On Site Septic System
ACKNOWLEDGEMENT
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Lan,' Alteration (Excavation,
C ading, Filling, etc.)
Fire
sprinkler System (Fire)
Fee S _ ___ _ (Other.
Fee S
The undersigned hereby acknowledges receipt of this limited
permit, i_,cluding acceptance of all special information,
terms, conditions or requirements written ab(we. The
undersigned understands and agrees under penalty of law
that this permit is stnc�ly It,
ited in scope to the work,
activity or improvement speeifted; that this permit does
not grant -ni, 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
subiect to inspecucn, approval or re)ecuon by the City.
Whenever so orden.d, the undersigned agrees to correct
any work tour u w be in violation of the conditions of
this permit.
Signature of Applicant
Fee
S
Fee
S
Fee
S
Fee
S
Fee a
Fee S
Fee S
ter -the -fact Invest:oation Fee S
TOTAL
State Surcharge: Fee S . _y_ )
Total Amount Paid to City Fee S 3d,SD
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Sign > of City Offic
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Code. White File ropy CanarY-Itupticttx'sCOPY Pink -Finance Copy Gold -Applicant's Receipt