HomeMy WebLinkAbout1985-05-02 Permit, Water Well #7901GENERAL PERMIT CITY PERMIT NO. 7901
CITY OF ORONO _
P.O.EOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(6 2) 473-7357
I �ecl
Owner Address J!
Cont or l S C C. Address / ��' •' _
CityLicense No. State License N .
•
RE ARKS AND SPECIAL CONDITNS
PERMIT TYPE AND FEE:
NEW
❑ ADDITION
Inside Plumbing (#fixtures_)
Fee
S
Water Meter (Size _)
Fee
S
Meter#
Remote #
Municipal Water Connection
Fee
S _
❑Copper
Municipal Sewer Connection
Fee
S
❑ PVC ❑ Cast
Q
MWCC SAC Charge
Fee
S
On Site Septic System
ACKNOWLEDGEMENT
❑ REPAIR
r Well
Equipment
Moving /Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fire _
Sprinkler System (Fire)
Dther:
Fee S IAfter-the-fact Investigation
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions or requirements written above. The
undersigned understands and agrees under penalty of law
that this permit Is strictly Umited in scope to the work,
activity or improvement specified; that this permit does
not grant any authorty to do work or activities requiring
separate permit approvals; and that this permit does not
grant authority to violate any provision of any City
ordinance or State law, rule or regulation. AU work shall be
done In strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subiect to inspection, approval or relectlon 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
TOTAL
Fee S ' eV
Fee S
Fee S
Fee S
Fee
S
Fee
S
Fee
S
Fee
S
State Surcharge: Fee S S�
Total Amount Paid to City Fee S`3C ' �)
This permit is not valid until the proper fee is paid and
it is approved by an authorized City Official.
Sign ure off ity Official /
- 7 �C i i"►mot �'.t�\ Tf
Code. White - mile Copy Canary Inspector's Copy
Pink -- Fbtince Copy Gold -Applicant's Receipt