HomeMy WebLinkAbout1984-11-20 Permit, Water Well #7725ff
GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner 4bn Cam'�-
'.r�reo'ractor ��t��_✓0 �� (mil �Q ZZ
u4N License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing (#t*ixtures_)
Water Meter (Size_)
Meter #
Remote I
CITY PERMIT NO. 7725
Date
Address
Address —e4-:2e) g j)
State License No.
❑ NEW ❑ ADDITION ❑ REPAIR
Fee S Water Well
Fee S —__-- -_-- Mechanical Equipment
Municipal Water Connection Fee S
❑Copper Q
Municipal Sewer Connection Fe,- S _ - --
❑ PVC ❑ Casl ❑__
MWCC SAC Charge Fee S .
On Site Septic System
ACKNOWLEDGEMENT
Fee S
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
Rant authority to violate any provision of any City
ordinance or State law, rule or regulation. All work stall be
done In strict compliance with all City ordinances, building
codes andior health department regulations, and shall be
subject to inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in %iolation of the conditions of
this permit.
Signatu A plic
� L�c
ing /Lifting Buildings
Fee S 4,041
Fee S
Fee S`_
Land Alteration (Excavation, Fee S
Grading, Filling, etc.)
Fire Fee S
rinkler System (Fire)
her:
ter -the -fact Investigation
TOTAL
State Surcharge:
Total Amount Paid to City
Fee S
Fee S
Fee S
Fee S 5-0
Fee '41), s-0
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signatu • of City Of lcial
t odc %hire I ile Copy Canar% Inspector's Copy Pink Finance Copy Gold -Applicant's Receipt