HomeMy WebLinkAbout1982-08-18 Permit, Water Well #6773GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 47 7357 ^c
Owner w Address
Contractor Address
� City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter #
Remote #
NEW ❑ ADDITION
Fee $
Fee $
Municipal Water Connection Fee $
❑ Copper n
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast ❑
MWCC SAC Charge
ACKNOWLEDGEMENT
Fee $
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 r' -•ly limited In scope to the work.
activity or improve) specified: that this permit does
not grant any autho. . to do work or activities requiring
separate permit approvals: and that this permit does not
grant authority to violste any provision of any City
ordinance or State law, rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
codes and!or health department regulations, and shall be
sublect to inspection, approval or rejection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Si ature of Applicant
CITY PERMIT NO. 6773,
����---
Date _ _
State Licenst. �o
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Other -
After -the -fact Investigation
TOTAL
State Surcharge:
Total Amount Paid to City
el
Fee S
Fee
S ae(L• v�
Fee
$
Fee
$
Fee
$
Fee
S
Fee
S
Fee $•sb
Fee Sy
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
S' a ur of City Official
Code: White File Copy Canary Inspector's Copy Pink - I inance Copy Gold Applicant's Receipt