HomeMy WebLinkAbout1987-07-08 Permit, Water Well #9103GENERAL PERMIT
Crnl OF ORONO
P.O. BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner
Contractor bu
City License No. 1�2_ _
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE --
Inside Plumbing Ofixtures
Water Meter (Size —)
Meter u
Remmte #
Municipal Water ( onnection
O Copper O
Municipal Sewer Connection
❑ PVC O Cast O
NiWCC SAC Charge
On Site Spetic System
ACKNOWLEDGEMENT
NEW
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
Tle unkrivrkd herrM acknawkdgt� mrrpt of !ht% limited permit,
tnitrdtrtg awrrur%:c it( all 4xvial information term, t+wadruortt ,r
fewarementt wnurn ahtnc TV urxkrvgrrctl undrr%und, and igrre`
utxkr rrnah� of bw that this permit n.tnidt Itmtcd in score to tux u,wk
hYnn% =w omrwowmrm cprall d. that tht% rrrmtl due• no( grant ant
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tt,mrrllawt: Ntth _'t Co tn)tnant.. MakLrtg ttxk!% and in health
tlrpnnmrnt rcgulautm.. and %lull he ,trhrtvt to tn.rrctttm Iplwtnal it
rr)cowm ht tlx Uit% Nhen•trr w, ordered. the unkfr Bred agrtr- to
ctwm't ant work found k, he to to L9utm of the trmdttkarta of his permit
I Signature of Applicant
CITY PERMIT N? 9103
77MY 7
Date _
Address �
—LLI�i_--f��
/��
Address 115�LO ,All r!%!S _
City ,� l,C /� ✓Pr- V�II�
❑ ADDITION ❑ REPAIR
Water Well
Mechanical Equipment
Fireplace/Wood Stove
Moi,ing/Lifting Buildings
Land Alteration (Excavation,
Grading. Filling, etc.)
Design Review
Fire
Sprinkler System (Fire)
Other.
-Xfter-the-fact Investigation
TOTAL
State Surcharge
Total Amount Paid to City
O REMODEL
Fee S S�v V
Fee S
Fee S
Fee S
Fee S
Fa, S
Fee S
Fee S
Fee S _
Fee S
Fee $
--7
Fee S
This permit is not salid until the properfm ii, pale and it is approved
bN an authorized City Offirial.
Sipria;LVe of City %OfFi(.ial r
(Ctxk White I Jr Corn
:'anon Impttuu't ('ups
Pink- Finswe Copy
Gold---AppMce0% RAtt^t