HomeMy WebLinkAbout1984-10-10 Permit, Water Well #7643GENERAL PERMIT
CITY OF ORONO
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473.7357
Owner 1—AWd% Ab&-t-eiS, r—A
I 'Ili
Contractor 600 S-T A 3e Lt..
City License No. # 1641
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: IS NEW ❑ ADDITION
Inside Plumbing 0fixtures_) Fee S
Water Meter (Size _) Fee S
Meter#
Remote #
Municipal Water Connection Fee S
❑Copper ❑
Municipal Sewer Connection Fee S
❑ PVC ❑ Cast r-
MWCC SAC Charge Fee S
On Site Septic System
ACKNOWLEDGEMENT
CITY PERMIT NO. 7643
Date /0 10 -1S1
Address /119s rrectvcrf L^ ICE: Qcvw
Address /S30f, HI-A.AU /Jo 7 AjAUACnde4
State License No.
❑ REPAIR
Water Well
Mechanical Equipment
Moving /Lifting Buildings
Land Alteration (Excavation.
Grading, Filling, etc.)
Fee S '_I
Fee c
Fee S
i ee S
ire Vee e
rinkler System (Fire)
Fee S IAfter-the-fact Investigation
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions nr requirpraents written above. The
undersigned understands and ape" under penalty of law
that this permit is strictly limited in scope to the work,
activity or improvement specified: that this permit does
not pant any authority to do week 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. All work shall be
done in strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be
subject to Inspection, approval at rejection 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
State Surcharge:
Total Amount Paid to City
Fee S
Fee S
Fee S
Fee S
1"fl
Fee S-30—
This permit is not valid until the proper fee is p .- ,: an,,.
it is approved by an authorized City Official.
Signature ity Official
Colic: White l ile Copy
Canary Inspector's Copy Pink —Finance Copy
Gold —Applicant's Receipt