HomeMy WebLinkAbout1982-08-03 Permit, Water Well #6760GENERAL PERMIT CITY PERMIT NO. --s760
CITY OF ORONO_
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
Owner �VUlU-E_ (_�PJ AIZIIC=::� Address �S�/<)FS r -
Contractor S `�,�-�— Address 4' W y
City License No. State Licer No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: <NEW ❑ ADDITION
Inside Plumbing( # fixtures ) Fee $
Water Meter (Size ) Fee $
Meter #
Remote #
Municipal Water Connection Fee $
❑ Copper 0 —
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast Q_
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 of 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. Ali 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 to ordered, the undersigned apses to correct
any work found to be in violation of the conditions of
this permit.
of Applicant
k_1
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S
Fee
Fee $
Fee $
Fee $
Other: Fee $
After -the -fact Investigation Fee $
TOTAL
State Surcharge: Fee $
Total Amount Paid to City Fee kv ls—1
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signi&(- of City Official
Code: White ATe Copy Canary —Inspector's Copy Pink -Finance Copy Gold --Applicant's Receipt