HomeMy WebLinkAbout1985-12-10 Permit, Water Well #8235GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 8235,
12 — It�'-�c
Date ,
Owner Slir1 Ir1t�N-r` �'•f1 Address
Contractor L Dr- ► ��Cl`� Address M�)0
• ���X ����
City License No. 1 49 State License No.
REMARKS AND SPECIAL CONDITIONS
PERYj' ND t'EE: X"NEW ❑ ADDITION ❑ REPAIR
Inside Plt.. +'U: V s.r) Fee S IWater Weil Fee S
Water Meter (Sit'! Fee S
Meter #
Remote _
Equipment
/Lifting Buildings
Municipal Water Connection
Fee S
Land A'teration (Excavation,
Fee
$
❑Copper ❑
Gralh ig, Filling, etc.)
Municipal Sewer Connection
Fc
_
Fire --
Fee
S
❑ PVC ❑Cast 0
Sprinkler System (Fire)
Fee
S_
MWCC SAC Charge
Fee S __
-Other;
Fee
S
On Site Septic System
Fee S
After -the -fact Investigation
Fee
S
ACKNOWLEDGEMENT
TOTAL
The undersigned hereby arhnowledges trorlot of dde Hrrmited
Parnell. hwhAdllg saesptaaee of a me" lnforneadoa.
larnee, eatdifi M at requirements wdUm above. The
m adneio ed ttttderstands and apaase under Penalty of law
tlet thla pavan Is sUkUy Hoalted to naps to the work.
activity or Imp tSta an& egneif". dial " paralt does
ad gnat any suikorily to do work or setivid" requiring
seperale Paneit approvals; and that Utia senait don not
NMI aulkokib to vitiate any provislaw of any city
aedlans" or State law. rule or rogubetton. AY work shall be
dam in ehiet eonepban" with s^ ' ordinances. building
eodn and/or health d"W "ona, sad tban be
subhect to bmwwdom, apt don by the V.
Whenever so ads a . the . - agree to c :t
ANY wart found to be in Nolan... .,. the condition. of
this permit.
Signature ui A •iic t
.. I ,
Code: White - FileCopf 0 Canary- •.spector'sCopy
L'
Statx Surcharge: Fee S.
Tout, Amount Paid♦z:,K'4v Fee S v`-
This permit is not -valid until the iar �.�xr fee is paid an4
it is approved by an authorized City Offtr' ,'.
Signature of City Official —
ifs_ �-• .�%t��� �.� /? Cal.' . f� �� ` K�
Pink -Finance Copy Gold -Applicant's Receipt