HomeMy WebLinkAbout1985-09-09 Permit, Water Well #8080GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner
Contractor - o Is-- we l
City License No. I(/
REMARKS AND SPECIAL CONDITIONS
CITY PERMIT NO. 8080
Date _ __qlqjs
Address / (a,3 �J J-eerldc-U_ -
Address 1 Q(:f , �-�LL�-� -7
State License No.
I
PERMIT TYPE AND FEE: NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing (#fixtures_) Fee S IWater Well Fee S
Water Meter (Size —) Fee S
Meter#
Remote #
Municipal Water Connection Fee S
❑ Copper n
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast ❑__
MWCC SAC Charge
On Site Septic System
ACKNOWLEDGEMENT
ical Equipment
/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
nkler System (Fire)
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S IOther: Fee S
Fee S !After -the -fact Investigation Fee S
The undmigned hereby acknowledges r66801 of thtr limited
pa It. Inhwbg wooplaaee of an WNW intoemation.
Mes& co"dans or requiresente wdttea above. The
undamped understands and @gem under Penalty of law
Umt " Permit is strictly tlsiMd in mope to the work.
activity or imp eovesan% weeilled; that thte Posit don
not pant My authority to do wank at activities requiring
0"We" Parnit aPProvak; and that *W Penh does not
Rant authority to violate any Provision of any city
ordlnSnee or State law. rule or regulation. Ali week shall be
do" in Strict eampba"s with am City ordinances. building
coda and/or kenith department regulations. and dial be
sublet to tyeetion, approval or nlectlon by the City.
Whanever so oadned. tie undmigmd epees to correct
any work found to be in violation of the conditions of
this parmit.
Signature of Applicant
TOTAL
State Surcharge: Fee S'-67�
Total Amount Paid to City Fee S �' S0
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