HomeMy WebLinkAbout1987-05-13 Permit, Water Well #9005i
i
GENERAL PERMH
CITY OF ORONO
P.O.BOX66
CRYSTAL BAY. MINNESOTA 55323
„ ,(612)473-7357
CITY PERMIT N? 9005
Date
0>Micr
Contractor Hc) /c
Address /^96 ^ . ^iT
City License No.
AAIn« 7
City AT
REMARKS AND SPECIAL CONDITIONS
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PERMIT TYPE AND FEE:
Inside Plumbing (((fixtures ___
Witer Meter (Size___)
Meter#__________
-)
NEW
Fee $
Fee $
□ REPAIR
Remote ((
Municipal Witer Connection
□ Copper □ ____
Fee $
Municipal Sewer Connection
□ PVC □ □
MWCC SAC Charge
On Site Spetic System
Fee $
O ADDITION
Witer Well
Mechanical Equipment
Fireplace/Wood Stove
Moving/Lifting Buildings
Land Alteration (Excavation.
Grading. Filling, etc.)
Design Review
Fire__________________
□ REMODEL
Fee $
Fee $
Fee $
fee $
fee $
Fee $
Sprinkler System (Fire)
Other ___________
After-the-fact Investigation
Fee S
Fee S
Fee $
fee $
Fee $
Fee S
*:
ACKNOWLEDGEMENT
The undcrMgnc J hca-by iickramlui|Krs rcinpi iiT this limited piTmit.
iwluding aa.-eriani.v «>f all sfv«.-ai inhimniidn. icnm. amditiens
retiuiremcnts written aNne. The ’indersigncd understands and agrees
under (vnalty nf b« that this permit is strxnly lirriitcd in wo|v to the work,
aetisity iw impnnemeni specified. th;n this |vrmit dt«s ma grant anv
authtmty toih* wrirk w activities requiring reparatc pemiii approvals; and
that this pcmiit does not grant authority t*» viobte any provisHtn i/anv City
tirdinance or Stale bw. rule or regublion. All wink shall he ihme in strKi
avmptbrke with all City ordinanu-s. building urIcs and/or health
department regubtions. and shall h* subject to inspection, approval or
a‘jec1ton by the Cilv Whenever s»» ordered, the undersigned agrees lo
correct any work found tii he in viobtiim of the conditiims of this permit.
Suture of Applicant
TOTAL
State Surcharge:Fee $___:<z:)
Total Amount l^id to City Fee $
This permit is not valid until the proper fee is paid and it is approved
by an authorized City Official.
Gxic; Whik* File Copy
Signaturrnf City Offici3LOa
Canary- Inspixior's Copy I’ink linancc Ctrpy Gtvld- Appliuuu's Rcodpi