HomeMy WebLinkAbout1986-08-01 Permit, Water WellGENERAL PERMIT
CITY OF ORONO
CITY PERMIT NO.8583
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Date.91^
Owner
Contractort
City License No----------________________
Address OxLCljlC
Address 1 ^7?^. Z??/?
State License No_________________________________
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE:
Inside Plumbing (#rixtures__)
-)
4
Water Meter (Size.
Meter#___
NEW
Fee $
Fee $
□ ADDITION □ REPAIR
Water Well
Remote #,
Municipal Water Connection
n Copper f]
Fee $
Municipal Sewer Connection
□ pVC DCast Q
MWCC SAC Charge
On Site Septic System
Fee $
Fee $
Fee $.
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee
Fee $_______
Fee $_______
Fee $_______
Fire
Sprinkler System (Fire)
Other:____________
After-the-fact Investigation
Fee $.
Fee $,
Fee $
Fee $
ACKNOWLEDGEMENT
The undanigncd hmby acknowltdtM nctipt of Ihit limited
pcimlt, indudtog accvpteacw of all «adal infomiatton.
tema, coaditfotia or nquinmante wdttea abovo. Tba
undardgnad undcntanda aad avaaa uadar paaalty of law
that this paiailt la aWctlir limited la acopa to tha work,
activity or taaprovamaat ^aclflad: that thla panait doaa
Bot grant any authority to do work or acttvitiaa raquiring
aaparate pannIt approvala: and that thla paimit doaa not
grant authority to violate any proviaioa of any City
ordinanca or State law, rula or regulatton. AD work ahaO ba
doaa In atrict compUanca with aD City ordlnaaeaa, buDdlng
codaa aad/or haalth dapartmant ragulalioBa, and diaD ba
aubiaet to bupaettoa. approval or rajactloa by tha City.
Whaaavar ao ordarad. tha undaraignad agraaa to corract
any work found to ba in violation of tha condltlona of
thto vaimit
TOTAL
State Surcharge:
Total Amount Paid to City
Fee $.
Fee
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Signature of City Official
Code: White-File Copy Canary-Inspector’s Copy Pink-Finance Copy Gold-Applicant's Receipt
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