HomeMy WebLinkAbout1982-12-27 Permit, Water Well #6912GENERAL PERMIT
CITY OF ORONO
— — * ■
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
CITY PERMIT NO " 6912 •
Date 12- ^ _______
Owner
Contractor KJ^^LL
City License No--------------------------------------
Adilress,
Address ---I/V^TKA^ ^------
State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: □ NEW □ ADDITION
Inside Plumbing(If fixtures...^) Fee S________
Water Meter (Size____) Fee $________
Meter If______________________
Remote If
Municipal Water Connection
D Copper n___
Fee $.
Municipal Sewer Connection
□ PVC □ Cast Q
Fee $.
MWee SAC Charge Fee $.
□ repair
On Site Septic System
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Fee S.
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee $_JLi5.
Fee S______
Fee S______
Fee S______
Other:.
After-the-fact Investigation
Fee $,
Fee $
ACKNOWLEDGEMENT
The undenigned hereby ecknowledgei receipt of this limited
permit, including acceptence of aU speciai 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 gruit any authority to do work or activities requiring
separate permit approvals: and that this permit doss not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. All work shall be
doiM in strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subject to Inspection, approval or reiection 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 of Applicant
Av
V
j of Applicant ^ / y
V
TOTAL
State Surcharge:
Total Amount Paid to City
Pec
Fee
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Sipniitiire oi^Gitv OffidaL,.
\Code: White-I-ile Copy Canary - Inspector’s Copy Pink I inance Copy (iold Applicant’s Receipt
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