HomeMy WebLinkAbout1984-08-24 Permit, Water Well #7584GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 5 53 23
(612) 4 73-735 7
CITY PERMIT NO. 7584,
Date A -2y- i q
Owner 4mj ,>IQGVW5'-S Address 3 76% 4A-9_Cr, _
Contractor ZAT7Z1! ER— L Address V 1 C-Tr)41 , ►A4 N
City License No. State License No. 1 01 t- r
REMARKS AND SPF''IAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing( # .fixtures
Water Meter (Size )
Meter M
Remote M
*v'!,W ❑ ADDITION ❑ REPAIR
I fee $ I On Site Septic System
Fee S- I Water Well
Municipal Water Connection Fee S
❑Copper ❑
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast ❑_____
MWCC SAC Charge
ACKNOWLEDGEMENT
Hee S
The undersi{»cd hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, cund'tions or requirements writaen above. The
undersigned understands and agrees under penalty of law
that this permit is strictly limited in scope to the work.
acuity or improvement specified: that this permit doe.
not grant an, authrrity to do work or activities requiring
sevarate permlI %pprovals, and that this permit does not
grant authority t violate any provision of any City
ordinance or State la. rule or regulation. All work shall be
done In strict compllan • with all City ordinances, building
codse and/or health d v_ tment regulations, and shall be
sub)ect to inspection approval or refection by the City.
Whenever to ordered, the underaigned agrees to correct
any work found to be in violation ut the conditions of
this permit.
Mechanical Equipment
Moving, Lifting Buildings
Land Alteration (Excavation,
Grading, i'ii!ing. etc.)
Fee
S
Fee
S 30 -
Fee
S
Fee
S
Fee
S
Other: Fee S
After -the -fart Inve,tigation Fce S
TOTAL
State Surcharge:
Total Amount Paid to City
!fee S
Fee S O
This permit is not valid until the proper fee is paid and
it is approved b an authorized ( ity official.
Signature of Applicant Signaturty Offieial
Code: White -Fie Copy Canary- Insip"ti,r's Copy Pint I finance Copy Gold AppIcani's Receipt