HomeMy WebLinkAbout1987-07-28 Permit, Water Well #9146r
GENERAL PERMn
CITY OF ORONO
1
P.O.BOX66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
CITY PERMIT N9 9146
Dale
Owner WO/(// T'\/ ArtH,P« /3^ t) Qjt/>.(>.k. A/"
Contractor Id s5> L^jL Cf Address U 7___________________________
iLeiLCity Doense No.
REMARKS AND SPECIAL CONDITIONS
jr)(ju<^4- Asi A/j
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PERMIT TYPE AND FEE
Inside Plumbiitg (^flxtures_
Witer Meter (Size___)
Meter#__________
-)
^NEW
Fee $
□ REPAIR
Fee $
Remote #
Municipal >^ter Connection
□ Copper □ ____
Fee $
Municipal Sewer Connection
□ PVC □ Cast □
MWCC SAC Charge
On Site Spetic S>'stem
Fee %
□ ADDITION
Witer WeU
Mechanical Equipment
Fireplace/Wood Stove
Moving/Lifting Buddings
Land Alteration (Excavation,
Grading, Filling, etc.)
Design Review
Fire_________________
Fee $
Fee $
□ REMODEL
Fee$_S^
Fee $_________
Fee $_________
Fee $________
Sprinkler System (Fire)
Other ___________
After-the-fact Investigation
Fee S
Fee $
Fee $
Fee S
Fee $
Fee $
1
ACKNOWLEDGEMENT
The underNigned hereby acknowted^ receipt of ihis limited permit
including acceptance of all special information, terms, conditions or
requirements written above. The undersigned understands and agrees
untfcr penalty of law that this permit is strictly limited in scope to the w irrk.
activity w imprrwement specified: that this permit diws not grant any
authority to do work or activities requiring separate permit approvals: and
that this permit does not grant authority to violate any provisitm of any City
ordinance or State law. rule or regulation. All wt>rk shall be done in qnct
compliance with all City ordinances, buildit^ cxxlcs and/or health
department a'gulations. and shall he subject to inspection, approval or
rejection by the City Whenever so ordered, the undersigned agrees to
civrnxt any work found to be in vitviation of the condiuons trf this permit.
Signature of Applicant
TOTAL
State Surcharge:Fee $
Total Amount I^id to City Fee $
This permit is not valid unul the proper fee is paid and it is approved
by an authorized City Official.
Signature of City Offld
i -a (j
L Code: White- File Copy Canary- Inspcxtor’s Copy Pink—Finance Copy Gold— Applicant's Retx*ipt