HomeMy WebLinkAbout1984-02-01 Permit, Water Well #7313I
GENERAL PERMIT
CITY OF ORONO
CITY PtRMIT NO. ” 7313 •
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner
Contractor
City License No------------------------------------ --
Date
m
Address La\C^ «
Address _______________________
State License No.
RE-MARKS AND SPECIAL CONDITIONS
r>p^ lu(EZ L li^Y'
PERMIT TYPE AND FEE:
Inside Plumbing ( M fixtures.
Water Meter (Size____)
Meter #__________
'Igf NEW □ ADDITION
_) Fee S_______
Fee $_______
Remote #
Municipal Water Connection Fee S.
□cdpper n
Municipal Sewer Connection
□ PVC □ Cast Q
Fee S.
MWee SAC Charge Fee S.
□ repair
On Site Septic Svstem
Water Well
Mechanical Equipment
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading, Filling, etc.)
Fee S.
Fee S_£Q
Fee S____
Fee S____
Fee S-------
eO
Other:.
After-the-fact Investigation
Fee S
Fee $
ACKNOWLEDGEMENT
The undersigned hereby acknowledges receipt of this limited
pennit. Including acceptance of aU special Information,
tenna. conditioru or requlremenU written abo\-e. The
undersigned understands and agrees under penalty of law
that this permit is strictly limited In scope to the work,
activity or Improvement specified: that this permit does
not grant any authority to do work or activltiea 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, approyal or rejection by the City.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this peimit.
Signature of Applicant y__/
TOTAL
State Surcharge:
Total Amount Paid to City
#
Fee S
Fee
This pennit is not valid until the proper f
it is approved by an authorized Coy (Jt'fic
Signaturc of City Official
P
and
Code White I Uc Copy Canary Inspector’s Copy link I inance Copy Cold Applicant’s Receipt