HomeMy WebLinkAbout1985-12-04 Permit, Water Well #8219GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 8219
Date I --�) — - OS I
Owner Address -7 5`_:S -3(?f n ck �l 1
Contractor17�nf-\ ���-`� }c�� ufF'�� Address
City License No. V State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing (#fixtures_) Fee S
Water Meter (Size —)
Meter#
Remote #
Fee S
Municipal Water Connection Fee S
❑Copper ❑
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast n
MWCC SAC Charge Fee S
On Site Septic System
ACKNOWLEDGEMENT
ater Well
chanical Equipment
/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
■
Fee S
Fee $ I
Fee S 1
Fee S I
ire Fee S
r System (Fire)
Fee S IAfter-the-fact Investigation
The undersigned tereby acknowledges receipt of this limited
Permit. Including acceptance of an special information.
Comes, conditions or tputnmeats wdttea above. The
undersigned undm'-"de and agrees under Penalty of law
that ehb Permit is strictly Use ted In scope to the work,
activity or improvement gnealflad. that ehb permit does
not pant any authority to do work or activities mquMng
separate permit approvals; and that fhb permit does not
great .1hority to violate nay provision of any city
osdiname or State law. rule or regulation. AN work sbaa be
done In Wlet compliance with all City ordliameee. building
codes and/or health department regulations. and •hall be
subleet to Ytapection, approval or ra*ctlon by the City.
Whenever so ordered. the undmlped agrees to conies
any waft found to be in violation of dw conditions of
thb permit.
Signature of Applicant
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S 1
Fee S 1
Fee S
Fee
Fee
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Offlci
Code: White —File Copy Canary— Inspector's Copy link —Finance Copy Gold —Applicants Receipt