HomeMy WebLinkAbout1986-8444 - new well GENERAL PERMIT CITYPERMITNO. g444 �
CITY OF ORONO �_�;��
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
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Owner � SQ� Address / L� �--�' l E''�✓-
Contractor L�_►�l�'��1�'►� vl��I l�c� � Address
City License No. � .�� State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: NEW ❑ ADDITION ❑ REPAIR
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Inside Plumbing (#fixtures_) Fee $ Water Well Fee $ ��'
Water Meter (Size_) Fee $ Mechanical Equipment Fee $
Meter#
Remote�# Moving /Lifting Buildings Fee $
Municipal Water Connection Fee $ _
Land Alteration (Excavation, Fee $
� Grading, Filling, etc.)
❑Copper
Municipal Sewer Connection Fee $ _ Fire Fee $
❑ PVC ❑Cast � Sprinkler System (Fire) Fee $
MWCC SAC Charge Fee $_ Other: Fee $
On Site Septic System Fee $ After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
The undersigned hereby acknowledges receipt of this limited -
permit, including acceptance of all special information,
terms, conditions or requirements written above. The Q j
undersigned understands and agrees under penalty of law State Surcharge: Fee ,p
that this permit is strictly limited in scope to the work, �j .
activity or improvement specified; that this permit does �
not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ �
sepazate 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 �aior health department regulations, �a snau be This permit is not valid until the proper fee is paid and
subiect to insnection, approval or reiection by the c�tY. it is approved by an authorized City Official.
Whenever so oxdered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this perxnit.
Signature of Applicant � Signature of City Of�ci
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Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt