HomeMy WebLinkAbout1983-06-10 Permit, Water Well #7026GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL, BtkY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 70261
Datc_�-Io — b�
Owner :;2a gS E Address _ I d 6o FOx_ S f
od
Contras for SroDo LAS SE L _ Address _L44-TK4
City License No. State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: O(NEW
Inside Plumbing ( # fixtures )
Water Meter (Size )
Meter # _
Remote #
❑ ADDITION
Fee $
Fee S.
Municipal Water Connection Fee $
❑ Copper ❑
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast [1
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
thii permit.
Signature of Applicant
C.l 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
Fee S
00
Fee S '76
Fee $
Fee S
Fee S
FeL $
Fee $
.20 0-0
Fee S - `s®
Fee $ 2-0'
This pennit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signatu 'ity
Code White - File Copy Canary Inspector's Copy Pink I inance Copy Gold Applicant's Receipt