HomeMy WebLinkAbout1987-07-22 Permit, Water Well #9139GENERAL raRMIT
CITY OF ORONO
‘
1f
P.O. BOX 66
CRYSTAL BAY. MINNESOTA 55323
(612)473-7357
CITY PERMIT N9 9139
Dale
Owner _
Contractor ^y\(\AAXdO^'lI\ L( IlQ C o
City License No.ILsl
/>o/r/t ^ hr •
r)ir\JL
City .r
REMARKS AND SPECIAL CONDITIONS
(OK ' dc^pu ,-v, r^f-pjc. lO-e.//
PERMIT TYPE AND FEE
Inside Plumbing (^fixtures_
Wiler Meter (Size-----)
Meter#__________
j/f I
NEW □ REPAIR
.)Fee $
Fee $
Remote#
Municipal Water Connection
□ Copper □ -----
Fee S
Municipal Sewer Connection
O PVC □ Cast □
MWCCSACChaige
On Site Spetic System
Fee $
□ ADDITION
Water Well
Mechanical Equipment
Fireplace/Wood Stove
Moving/Lifting Buildings
Land Alteration (Excavation,
Grading. Filling, etc.)
Design Review
Fire_________________
□ REMODEL
Fee $
Fee $
Fee $
Fee $
Fw $
Fee $
3C?.oe)
1
Sprinkler System (Fire)
Other-----------------
After-the-fact Investigation
Fee S
Fee S
Fee $
Fee $
Fee S
Fee $
ACKNOWLEDGEMENT
tlie unkfsigiKd hereby acknowlcdseir rrccipi vt this limited permit,
inriuding aoDepunoe of aU speciai infonnation. lenm. additions <v
RMuiieinenLs wiitien above. The undenigned understands and agrees
under penalty of law that this permil is strictly limited in scope to the work,
activity nr improvement speciTicd: that this permit docs not grant any
authority to do work or activities requiring separate permil approvals: and
that this permit does not grant authority in viokitc any provision cf any City
ordinance or State law. rule or regulation. All work shall be done in strKt
compliance with all City ordinances, building uvies and/or health
departme.il regulations, and shall be sut^ In inspection, approval or
rejection by the City. Whenever so ordered, the undersqmed agrees to
cv>rrei1 any work found lobe in violation of the conditions of this permit.
Signature of Appljpant
TOTAL
State Surcharge:Fee $
Total Amount Rud to City Fee $
This permit is not valid until the proper fee is paid and it is approved
by an authorized City Official.
Signature ofreof^OBieW / ^
f
Code While-Fife Copy
L
Canary—Inspcclor’s Copy
Rk—
Pink- Finance Copy Gold—Applicant's Receipt