HomeMy WebLinkAbout1982-12-29 Permit, Water Well #6915GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
CITY PERMIT NO. 691�
Date , � l — b
Owner T SSE[ Address �aX 5�'
Contractor STeyeta S 1►-)ELL Address MAQCV- i? Al r`S
City License No.
RI MARKS AND SPECIAL CONDITIONS
PERMIT TYPE=. AND FEE
❑ NEW ❑ ADDITION
Inside Plumbing ( # fixtures ) Fee $
Water Meter (Size )
Meter #
Remote #
Fee $
Municipal Water Connection Fee S
❑ Copper ❑
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast
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
:{eplrate permit approvals; and that this permit does not
giant authority to violate any provision of a.�y 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.
W..enever so ordered, the undersigned agrees to correct
any work found to be to violation of the conditions of
it's permit.
Signar.lre of Applicant
State License No.
❑ RFPAIR
On Site Septic System Fee $
Water Well Fee $
ZO,00
Mechanical Equipment Fee $
Moving/Lifting Buildings Fee $
Land Alteration (Excavation, Fee S
Grading, Filling, etc.)
Other: F:e $
After -the -fact Investigation Fee $
TOTAL
State Surcharge: Fee $
J �
Total Amount Paid to C;ty Fee $alo,_
This permit is not valid until the proper fee is paid _ind
it is approved by an authorized City Official.
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Code: White —Pik Copy Canary —inspectttr's Copy
I•inance Copy Gold Applicant's Receipt