HomeMy WebLinkAbout1984-07-12 Permit, Water Well #7502CITY _—?SOZt
GENERAL PERMIT
CITY OF ORONO /1_/,- ,?q
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
OwnerVe—NayaK_ Address
Contractor o k Address
zct-
City License No. /C; State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPF AND FFE: ❑ NEW ❑ ADDITION ❑ RFPAIR
Inside Plumbing( !( Fixtures ) Fee $ I O'i Site Septic System
Water Meter (Size__)
Meter #
Remote M
Fee S _
,:;'tticip.! :'A'nG:r Connection Fee S
-o.-per ❑
Munii-1,J 5,rwer Connection Fee S
❑ PVC ❑ Cast Q___----
MWCC SAC Charge Fee S
AC'KNOW LEDCEM ENT
The undersigned hereby acknowledges receipt of this Limited
permit, including acceptance of all special information,
terms, cunditions 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 dies not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. All work shall be
done In strict coml'lance with all City ordinances, building
codes and/ health department regulations, and shall be
sublet, to inspection, approval or rolection by the Citv.
Whenever so ordered, the undersigned agrees to correct
any work found to be In violation of the conditions of
Oil permit.
Signature of Applicant
Water W •11
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (I:xi-avation,
Grading, Filling, etc.)
Other:
After -the -fact Investigation
101AL
State Surcharge:
Total Amount Paid to City
OF
Fee
S
Fee
?n
S
Fee
S
Fee
S
Fee
S---
Fee
S
Fee
S
Fee S �v
Fee S
This permit is not talid until the proper tee is paid and
it is approved by an authori; ed City Official.
Sign a of C ity Official
Code While I ile Cop)
Canary hispe. tor% Cop)
Pink I inance Cops Gold Applicant'% Receipt