HomeMy WebLinkAbout1982-04-29 Permit, Water Well #6671GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)) 4733-7357
Owner "ii&o
Contractor &,kl j
City License 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 a
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast n
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 ahaL be
done in aWct compliance with all City ordinances, building
codes and/or health department regulations, and stall be
abject to inspection, approval or -election 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 A plicant
CITY PERMIT NO. 66711
� r
� . Z,� i -N, � �
Address S V lee�
Address
State I i-ense No.
❑ REPAIR
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee
$
Fee
$
Fee
$
Fee
$
Fee
$
Other: Fee S
After -the -fact Investigation Fee $
TOTAL
State Surcharge:
Total Amount Paid to City
Fee $
Fee $ OtiJ . �l C1
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official. ,
Jit^' 1�e of City �)t�lllal�1 �1
Code. White -I He Copy Canary- Inspector's Copy Pink -I inance Copy Gold -Applicant's Receipt