HomeMy WebLinkAbout1982-10-01 Permit, Water Well #6833GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 6833 1
Date
Owner QaLj I -Amg / it Address /2:77 AL FE-eAvD&1=6
Contractor STbDOLA W ELL_ Address MI��
City License No.
REMARKS AND SPECIAL CONDITIONS
State License No
,icey /C •L ► � f�
PERMIT TYPE AND FEE.
Inside Plumbing ( # fixtures
Water Meter (Size )
Meter #
Remote #
YNEW ❑ ADDITION
Fee $ 1
Fee $
Municipal Water Connection Fee $
❑ Copper
Municipal Sewer Connection Fee $ _
❑ PVC ❑ Cast Q—
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee $
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all 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. Ali work shall be
done in strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subject to inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agrees to corre=t
any work found to be in violation of the conditions of
this permit.
Signature of Applic'
❑ REPAIR
On Site Septic System Fee
ee
Water Well Fee $ ZQ
Mechanical Equipment Fee $
Moving/Lifting Buildings Fee $
Land Alteration (Excavation, Fee $
Grading, Filling, etc.)
Other: Fee $
After -the -fact Investigation Fee $
TOTAL
State Surcharge: Fee S Sn
Sb
Total Amount Paid to City Fee $ 2-0
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official /
Code: White -File Copy Canary -Inspector's Copy Pink -Finance Copy Gold --Applicant's Receipt