HomeMy WebLinkAbout1987-07-14 Permit, Water Well #9119GENERAL PERMIT
CITY OF ORONO
P.O. BOX 66
CRYSTAL. BAY. MINNESOTA 55323
(1 (612) 473-7357
Owner
Contractor. ics.
City License No. , ���1 tk I
EMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE -
Inside Plumbing („ fixtures )
Water Meter (Sipe )
Meter #
Remote N
Municipal Water Connection
❑ Copper ❑
Municipal Sewer Connection
❑ PVC ❑ Cast ❑
MWCC SAC Charge
On Site Spetic System
ACKNOWLEDGEMENT
XNEW
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
tin• unkrsrlrnd hrrrM aokno,wldjt. reto'rrw d this limited prrmit.
minding aorptarkr od all ,rxttial information. leans. u,rklmon, ow
nyt,cimn nt, unnen at%,sr 7ht• undersigned understand, and agog
urkkr rx•nalt% of law that this rtrmt rs urml% limited m voile u, the work.
anon or imr"mcntnt srxtrrKd. that this flemi the, not grant am
authontt todo work rw aamtkr nyutnng wrumk• Ivrmn appnnats. and
that this prrmn don. not reran a utlnwrth n, %iNale am pmsrvon dam Co s
•,nhnarke o,r Stake law rule ow alrulanon %ll work ,hill he don• m ,trxt
Complarke with all Cm onlmmrkY•. htukling axle, an&or health
skpanmrnt nrrulanom. and shalt tie ,uhµtt to imlitnon. apprmal or
rejectionh, the ('m n•u• wher K, onknd. the underuRnd agree, t,i
o„rrcit am w,rk found to Iv in „,Jatum d the cnnitnom d this rvrma
Signature of Appl"nt
(!::2) -A
7-7
CITY PERMIT N? 9119
10t
[ate
Address
Address�;.;�,�S��l
❑ ADDITION
Water Well
❑ REPAIR
Mtchanical Equipment
Fireplace/Woad Stove
Moving/Lifting BWldines
Land Alteration ( Excavation.
Grading. Filling, etc.)
Design Review
Fire —
Sprinkler System (Fire)
Jter-the-fact Imrs6gation
TOTAL_
❑ REMODEL
Fee S U�
Fee S
Fee $
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
State Surcharge: Fee S '
Total Amount Paid to City Fee S ?X
c! ,k- ,0 J3 h /
This permit is not valid until the proper fee is paid and it is approved
by an authorized City Official.
Signature ( 1City Official ?
�'r 1,ct� f
Cmle Whili File Cops Canam ImMior's Copy fink Finamv Cops Gold- Appliunn('s Rraipt