HomeMy WebLinkAbout1982-09-28 Permit, Water Well #6828�'ENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 682 1
Date���
Owner�o�ZL����.,a_..e.:.,_ Address �J�<�5 TL�1flitr2 S
Contractor Address
City License No. State License No,
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: )(NEW
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter #
Remote #
❑ ADDITION
Fee $
Fee $
Municipal Water Connection Fee $
[]Copper
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 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
done in strict compliance with all City ordinances, building
codes and/or 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 violation of the conditions of
this permit.
Signature of Applicant
❑ REPAIR
On Site Septic System
Fee
S
Water Well
Fee
$
Mechanical Equipment
Fee
$
Moving/Lifting Buildings
Fee
$ _ —
Land Alteration (Excavation,
Fee
$
Grading, Filling, etc.)
Other:
Fee
$
After -the -fact Investigation Fee $
TOTAL
sue'
State Surcharge: Fee $
Total Amount Paid to City Fee S-0 --!
This pennit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Of!`:ial
Code White File Copy Canary --Inspector's Copy Pink-I-inance Copy Gold Applicant's Receipt