HomeMy WebLinkAbout1986-01-16 Permit, Water Well #8302GENERAL PERMIT
CITY OF ORONO
P.O.BOX fib
CRYSTAL BAY, MINNESOTA 55323
((i 1 `_') 473-7357
CITY PERMIT NO. 8302
Date « u�
Owner �� � ✓� Address ) "�/ �Prf �le�
Contractor tJ �54 ) a t'L. V 12 I Address � r r "
Citv License No. (0L-1 State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE: AND FFI::
Inside Plumbing Ofixtures_)
WaterMeter (Size_)
deter #
Remote 1
❑ NF:W ❑ ADDITION
Fee S
Fee S
Municipal Water Connection--
❑Ctrpper n
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast r1
MWC'C SAC Charge Fee S _
On Site Septic System
ACKNOWLEDGEMENT
❑ REPAIR
Water Well
!Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation
Grading. Filling. etc.)
Fire
Sprinkler System (Fire)
her:
Fee S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee
S
Fee S lAfter-the-fart Investigation Fee S
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 does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. All work shall be
dune In strict compliance with all City ordinances, building
codes and/or health department regulaUons, and shall be
subject to inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agrees to correct
•ny work found to be in violation of the conditions of
this p•rrmt.
Signature of Appliran�� ,
TOTAL
State Surcharge:
Total Amount Paid to Citq
1 Fee S ' S?i I
Fee S) • �Z' I
This permit is not valid until the proper fee is paid and I
it is approved by an authorized City Official.
Signature of City Official
i
Code Mite I ile (bp) Canar) Inspector's (bpi Pink I inance ('op) Gold Applicant's Receipt