HomeMy WebLinkAbout1985-05-02 Permit, Water Well #7900If
< / GENERAL PERMIT
/ CITY OP ORONO
I
P.O.BOX66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner / /V\Address
CITY PERMIT NO. 7900
Date_____
ConXtwiLitt Ij AddicM tO ^
City License No..
REMARKS AND SPECIAL CONDITIONS
State License No.
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PERMIT TYPE AND FEE:
Inside Plumbing (ffixtures__)
Water Meter (Size__)
Meter#______________
EW □ ADDITION
Fee S_______
Fee S_______
Remote #.
Municipal Water Connection
□copper □
Fee S
5I
I Municipal Sewer Connection
□ pVC Dcast Q
; MWCC SAC Charge
I On Site Septic System
Fee $
Fee $
Fee $.
□ REPAIR
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filli/iR, etc.)
Fire
Sprinkler System (Fire)
Other:_____________
Fee 5
Fee S __
Fee $________
Fee $________
After-the-fact Investigation
Fee $.
Fee $.
Fee S
Fee $.
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ACKNOWLEDGEMENT
Tht undmlaMd bmby MfcaowltdeM ncolpt of th^ UmlMd
pcmlt, taMludlng oecoptMiN of oD 9oeUl tafomattoa.
taaai, eoedittoaa or loqiilnnanta wdttaa abova <a
undanlgnad undantaada aad agraai indar paaa'*
that (bla paaait ia atitetip Urnllod la aeopa to
aetMCp Of taapravamaat 9acUlad: that thla pat ^
aot gnat aap autboiltp to do wort oc aetfvMaa'fo^aiirtag
aapaiata pamlt approvala: aad that dda pannlt doaa not
gnat autboiitp to violate aay pvovidoa of aap City
oadtaUBco or Stete law, rula or raguUttoa. AB work diall ba
doaa fai Blitel compMaaaa witb AB City ordbuaeoa. building
codaa and/or ^^aaHb dapaHmaat ragiilattoaa. Md dudl ba
■ubioct to iMpwtloo, approval or nlaetloa by tba City.
Wbanavor ao ordatod. tba • -tendgnad affoas to comet
aay work found to ba in *1100 of tho coadittoaa of
thla permit.
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Signature of Applicant
TOTAL
State Surcharge:
Total Amount Paid to City
Fee $.■ sv
Fee
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Siff^n of City Official
Code: White-File Copy CuMfy-lnipectoi'tCopy Ptok-Copy Go,' ^pplic»t*tReceipt