HomeMy WebLinkAbout1986-10-29 Permit, Water Well #8763r't
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GENERAL PERMIT
CITY OF ORONO
CITY PERMIT N9 8763
P.O.BOX66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Date /
Owner
yl (612)473-7357
Mil/^
Contractor f Address
City license No. . 0^-1-!■
ly)^& Addiws
firenrJn
V-Mh)OCK-fb A
REMARKS AND SPECIAL CONDmONS
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PERMIT TYPE AND FEE
Inside Plumbing (^fixtures_
Witer Meier (Sine___)
Meters#__________
-)
^NEW
Fee $
□ REPAIR
Fee $
Remote!^
Municipal ^ter (Connection
□ Copper □ ____
Fee $
Municipal Sewer (Connection
□ PVC □ Cast □
MWee SAC (Charge
On Site Spetic System
Fee $
□ ADDITION
Water WeU
Mechanical Equipment
Fireplace/Waod Stove
Mo\ing/lifting Buildipgs
Land Alteration (Excavation.
Grading, Filling, etc.)
Design Review
Rre_________________
Fee $
Fee $ '7^*^
a REMODEL
Fee S 3<^'CrV
Fee $_________
Fee S_________
Fee S_________
Sprinkler System (Fire)
Other ___________
After-the-fact Investigation
Fee $
Fw $
Fee S
Fee S
Fee $
Fee $
ACKNOWLEDGEMENT
The undenignni herein acknonlet^es iccei|x of this limited permit,
including accepunce ti all special information, terras, conditions or
lequiremenLs wntien abtne. The undersigned understands and agrees
under perulty oflaw that this permit is strictly limit'd in scope to the ssiKk.
adisriy or improscmcni spcciricd: that this permit docs not grant any
authority to do work or actisities requiring separate permit approsaK: and
that this permit does not grant authority to sroiate any prosision any City
ofdinanoe or State law. rule or nrgulation. All work shall be dime in strict
compliance with all City ordinances, building codes and/or health
department regulations, and shall be subject to inspection, appmsal or
rejection by the City. Wheneser so orde^. the undersigrK'd agrees to
correct any work found to he in siolatitNi of the conditions I'f this permit
Signature of Applicant
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TOTAL
State Surcharge:
Total Amount ftid to City
Fee $ __
Fee $ l0io,O7>
This permit is not valid until the proper fee is paid and it is approved
by an authorized City Offidal.
Signature of City Official/T /"I
7^
Code; White- File Copy Carury- Inspector’s Copy Pink—Finance Copy Gold— Applicant's Receipt