HomeMy WebLinkAbout1985-08-09 Permit, Water WellGENERAL PERMIT
CITY OF ORONO
CITY PERMIT NO.
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Date,
8029
K^- SS'
t
Owner lien Address
Contractor 0(1 H oi^ S / I Address /^ (io H U/j/f T "j'lC^CKJ
l(o^_________ ‘City License No..State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE:
Inside Plumbing (#fixtures__)
^NEW □ ADDITION □ REPAIR
Water Meter (Size__)
Meter#_______
Fee S
Fee S
Remote #.
Municipal Water Connection
QCopper rn
Fee $
Municipal Sewer Connection
□ pVC Dcasl Q
MWCC SAC Charge
On Site Septic System
Fee S
Fee $
Fee S.
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee
Fee $________
Fee $_________
Fee $_________\
Fire
Sprinkler System (Fire)
Other:______________
After-the-fact Investigation
Fee $.
Fee $.
Fee $
Fee S.
i.
ACKNOWLEDGEMENT
The undentgiteil haraby Mkoowladges ncelpt of thla limited
pennlt. including ecceptenc* of all ipecial Infonnatton.
terais, condfttoni or icquiremcnte written above. The
undeirigned undantendi and acreea under penalty of law
that thla permit is strictly limitec* in scope to the work,
activity or improvement dpeclfled: 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. rtUe or regulation. AO work khall be
done in strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subject to Infection, epproval or rejection 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 gj^pplicant
TOTAL
State Surcharge:
Total Amount Paid to City
Fee $,
Fee i
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
TrIYn
Code: White-nie Copy Canary-Inspector's Copy Pink-Finance Copy Gold-Applicant’s Receipt