HomeMy WebLinkAbout1987-04-14 Permit, Water Well #8964GENERAL PERMn
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P.O. BOX 66
CRYSTAL BAY. MINNESOTA 55323
(612)473-7357
CITY PERMIT N9 8964
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City License No. - _________________
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AAIm« jS^y^Iri Uyj) > f /Ja ♦ ‘7____________
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REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE
Inside Plumbing ((Mixtures___)
Water Meter (Size___)
Meter tt_____________
X NEW
Fee S
Fee S
□ REPAIR
Remote#
Municipal Witer Connection
O Copper □ ____
Fee S
Municipal Sewer Connection
□ PVC □ Cast □
MWee SAC Charge
On Site Spetic System
Fee $
□ ADDITION
>\^ter Well
Mechanical Equipment
Fireplacc/Wood Stove
Moving/UBing Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Design Review
Fire_________________
Fee $
Fee $
□ REMODEL
FccsJ£^
Fee S_________
Fee $_________
Fee $_________
Sprinkler System (Fire)
Other ___________
Aricr-ihe-fact Investigation
Fee S
Fee S
Fee $
Fee $
Fee $
Fee $
ACKNOWLEDGEMENT
The uniicniiimtl hetehy ackmmlnl(R« avetpi ttf ihis limited permit,
indudiiti! acurpiincc all ^rweial infiirmauim. terms omditions iw
a*quirement> written abiiw. The undervpicd under>andv and .igrccs
under |x-nalt> nf law that th^ permit r Mrictly limited in w:n|« u» the work,
activity or improvement ^prciTicd; that this |vrmit diXR rua grant any
authority todo work inactivities n-quiring vparate permit approvah: anil
that this permit divs not gram authority to vinbie any provision irfany Citv
ordinamv or Sate bw. rule or n*gulation All work shall he dom- in slnct
compliant with all City ordinances, building aales and'or health
department regubtiorw. and shall K- subject u» inspection, approval or
ri’jsxiioo by thi* City >k'heiK’ver so ordered, the undersigned agrees to
oornvt any wink found to he in viobtum of the amditHms of this permit
Signature of Applicant
TOTAL
State Surcharge;Fee $,sz>
Total Amount ftiid to City Fee $
This permit is not valid until the proper fee is paid and it is approved
by an authorized City Official.
Signature of City Officid ^
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Code; White File Copy Canary Inspivtor's Copy Pink FinaiHx* Copy Gtikl ApplicanTs Receipt