HomeMy WebLinkAbout1986-08-01 Permit, Water Well #8586I
GENERAL PERMIT
CITY OF ORONO
CITY PERMIT NO.8586
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Date
Owner____.
Contractor
f City License Nn. f ^--------------
Address 55d^ vJ/iV. M.
Address l^^OL> 7 IHn
State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE:fp NEW
> Inside Plumbing (ffixtures__)
Water Meter (Size
Meter#___
I Remote #__
J
Municipal Water Connection
OCopper ri
□ addition □ REPAIR
Fee $__________Water Well
Fee S-----------------Mechanical Equipment
Moving /Lifting Buildings
Fee S-----------------
Municipal Sewer Connection
□ pVC Gcast Q.
MWCC SAC Charge
Fee S
On Site Septic System
Fee S
Fee $.
Fee S
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee $
Fee $,
Fee $.
' Fire
Sprinkler System (Fire)
Other:_____________
After-the-fact Investigation
Fee $.
Fee $,
Fee $
Fee S.
ACKNOWLEDGEMENT
Th« unitonttmd hcnby ■JknowtodfN raccipt of thto Uraiud
pcnntt. including aecoptancc of aO 9«clal tnfonnatton.
Ums, conditfona or nQuirtmmta written above. Tba
undarrignad undantenda and affaaa undar panalty of law
that thla paimlt U atitctly limited In aeopa to Uia work,
activity or improvamant dteciflad: that thla parrait doaa
not gnat any authority to do work or actlvitiaa raqulrlng
aapante paimit approvala: and that thia permit doaa not
grant authority to violate any provirioa of any City■mnwawnoo^ wwr -------------------- --- ------------
ordiaanca or Stete law. rule or ragulatlt'n. AU work ihall be
* doiM la atriet compliaaca with all City ordlaaacaa. buildlag
eodaa and/or haalth dapaitnaat ngulattona, and ahall ba
I
______________________ngulattona,------------------
aublact to taupaettoa. approval or niaettoa by the City.
Whanavar ao ordand. the uadaratgaad agnaa to comet
aay work found to ba in violation of the conditlona of
thla paimlL
L.
Signatur^f A^plicant^ ^ ^
TOTAL
State Surcharge:
Total Amount Paid to City
Fee $.
Fee $
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
•V*
Codt: Wklte-Hk Copy Cgaiiy-tavoctof'iCopy Pink-Finance Copy Gold-AppUcant*! Receipt
...a—