HomeMy WebLinkAbout1984-01-05 Permit, Water Well #7286GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 7286
Date i -s--gel
Owner Address Sln Fpre sT� A to m s LA
Contractor1: Address !"!' k 1�'[ AJ
City License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FLE: 0"NEW
Inside Plumbing I # fixtures I
Water Meter (Size )
Meter N
Remote 0
0 ADDITION
Fee S
Fee S
Municipal Water Connection Fee S
❑Copper
Municipal Sewt r Connection Fie S
❑ PVC D cast Q
MWCC SAC Charge
ACKNOWLEDGLM ENT
State License No.
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S
Fee S Ge
AD
Fee S
Fee S
Fee S
Other: Fee S
Fee S_ I After -the -fact Investigation Fee S
The undersigned hereby acknowledges receipt of this limited
permit. Including at:teptance of an special information.
terns, conditions tw requirements written above. The
undersigned understands and "nag under penalty of law
that this permit is strictly limited in scope to the work.
activity or improvement specified: that We permit does
oat pant any authority to do work cr activities requiring
separate permit approvals: and that this permit does not
pant authority to violate any provision of any City
ordinance or State law, rule or regulation. All work shall be
done In strkt compliance with all City ordinances, building
codes and/or health department regulations. and shadl bt
sub)ect to Inspection, approval or m)ecUon by the City.
Whenever to ordered, the undersigned epees to cormet
an) work Hwrnd to be in violation of the conditions of
this permit.
Signature of Applicant
TOTAL
State Surcharge: Fee S • S'0
Total Amount Paid to City Fee S .20. SO
This pennit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
SiRna
( ode While I do Copy Canary Inspector's Copy
Pink I inance Cops
Gold - Xpplicant's Receipt