HomeMy WebLinkAbout1986-07-16 Permit, Water Well #8565GENERAL PERMIT CITY PERMIT NO. 8565
CITY OF ORONO
P.O.BOX 66 Date _
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner i�
C C k ✓ t t;�l JL- Address 30919 a r d ► ecJ Ln
ContraL . i PAC, G 1 Address
City License No. I U - T
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (01f xiures_)
Water Meter (Size_)
MeterN
Remote ';+
State License No.
NEW ❑ ADDITION ❑ REPAIR
Fee
Fee
Municipal Water Connection Fee
❑Copper n
Municipal Svwer Connection Fee
❑ PVC ❑ Cast n
MWCC SAC Charge Fee
On Site Septic System Fee
ACKNOWLEDGEMENT
e — (Water
Well
Fee
S 30.
(
S _ _—__ iMechanical
Equipment
Fee
S
Moving /Lifting Buildings
Fee
S
S
Land Alt ration (Excavation,
Fee
S
Grading. Filling, etc.)
Fire
Fee
S
S _
Sprinkler System (Fire)
Fee
S
they:
Fee
S
S
After -the -fact Investigation
Fee
S
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of ell special information•
teems. 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 provislon of any City
ordinance or Slate law, rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
codes and/or health department regOitions, and @hall be
sub)eet 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.
Signatur. -)f Applicants
TOTAL
State Surcharge:
Fee S
Total Amount Paid to City Fee Sa�d•S J
This permit is not valid until the proper f. d and
it is approved by an authorized City Official.
Signature of City Official
Code white I de Cup- Canary inspector's Copy Pink -Finance Copy Gold -Applicant's Receipt