HomeMy WebLinkAbout1982-08-02 Permit, Water Well #6757GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner S
Contractor
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing( # fixtures )
Water Meter (Size )
Meter #
Remote #
NEW ❑ ADDITION
Fee S
Fee S
Municipal Water Connection Fee S
❑ Copper El
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast n
MWCC SAC Charge Fee S
ACKNOWLEDGEMENT
The undersigned bereby acknowledges receipt of" limited
Permit, Including seesptanae of all me" information,
terms, conditions or requinmsai wtitwn above. Tke
undemidood underdands and agtw under penalty of law
that thle permit is faledy limited In mope to the week,
activity or improwmant spodfled: that gale permit does
rat want any oulhosi4 to do week or ealmdes requiring
aegafnt. permit approvele: and that tide permit don not
wlrt aulhority to violate any Provision of any City
aP�aanes of State law. rule or regulation. All work ahN be
tla�a Is $Oki compliance wills as City ordinances. building
eegn and/or hnith department rewuletious, and call be
sableet to Inspection. approwd or rejection by the City.
whaaewr so angered, tin undersigned agrees to correct
any work found to be in violation of the conditions of
1W penult.
Signature of Applicant
CITY PERMIT NO. .67511
Date Y—C;�-
Address 7Vr"-eiv Z41.
Address " a ---,
State License No,
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S
Fee $ �D OD
Fee S
Fee S
Fee S
Other: Fee $
After -the -fact Investigation
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee S `�5d
Fee $�'�
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Sign, - of City Official
Code: white -File Copy
Canary --Inspector's Copy
Pink-FinanLC Cspy
Gold --Applicant's Receipt