HomeMy WebLinkAbout1983-06-24 Permit, Water Well #7044GENERAL PERMIT Cl1-NALRMITNo. -7044,
CITY OF ORONO
N.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
OwnerAAddress
Contractor Alt(Address 0 & 14AJ
II City License No.
W
I
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: kNEW
Inside Plumbing ( # fixtures )
Water Meter (Size_)
Meter #
Remote #
❑ ADDITION
Fee S
Fee S
Municipal Water Connection Fee $
❑Copper
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast
MWCC SAC Charge
ACKNOWLEDGEMENT
State License No.
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S
Fee S 070- 00
Fee S
Fee S
Fee S
Other: Fee S
Fee S I After -the -fact Investigation Fee S
The understand hereby acaaowlsagN r•c.ivt of thts limited
p—it. tneludine Skeaeptaoee of all petal information,
tams, cnndltlone or requirements written Sib. va. The
endersigad undemlasnds and &grew under penalty of law
that " permit Is strieth limited in scope to We wore,
activity of improvement Specified: that this pssmlt does
not groat any authodty to do work or activities requiting
"Palau tarmit approva4: and that this permit does not
grant autbosity, to Violate any provtsfon of any City
ardinanee or Stara law, rule or regmlation. AD wort shall be
dew m eldet ea®pLaoce with all City ordinsncea building
nodes an department
heath deparent regulations. ad @ all be
sublet to Iaspeedoa, approval or ralecton by the city.
Whenever to arda ed, the undersigned agrees to correct
any wort found to be in violation of the conditions of
Shia pesmit.
Signature of Applicant
TOTAL
Mate Surcharge: Fee S
Total Amourt Paid to City Fee S�
Phis permit is not vand until the proper fee :s paid and
it is approved by an authorized City Officidl.
Code. White- FW Copy a a.fy .. tntpxtimf's Copy Pint - I inane Copy (kola ,pplicant's Receipt