HomeMy WebLinkAbout1983-09-01 Permit, Water Well #7137GENERAL PERMIT CITY PERMIT NO.--71311
CITY OF ORONO
P,O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner 4141 oc `I Address
Contractor �S�ac(I it���/I (i Address_ 29 66
City License No.
REMARKS AND SPECIAL CONDITIONS
State License No.
PERMIT TYPE AND FEE: [2 NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing ( # fixtures ) Fee $
Water Meter (Size ) Fee $
Meter #
Remote #
Municipal Water Connection Fee $
❑ Copper ❑
Municipal Sewer Connection Fee $
❑ PVC ❑ Ca it ❑
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee $
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of W special Information,
terms, conditions or requirements written above. The
undersigned understands and agrees under penalty of law
that this permit is strictly Limited in scope to the work,
activity or improvement specified: that this permit does
not grant any 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 andjor health department regulations, and shall be
sublect to inspection, approval or refection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signature of Applicant
On Site Septic System Fee S
Water Well Fee S , U • GU
Mechanical Equipment Fee S
Moving/Lifting Buildings Fee S
Land Alteration (Excavation, Fee S
Grading, Filling, etc.)
Other: Fee S
After -the -fact Investigation Fee S
TOTAL
State Surcharge: Fee S s�
Total Amount Paid to City Fee S, Ul �C)
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
I
Code White - File Copy Canary - Inspector's Copy Pink I inance Copy Gold Applicant's Receipt