HomeMy WebLinkAbout1984-7493 - new well GENERAL PERMIT CITYYERMITNO. -_—�493 �
� ITY OF ORONO . __� ���
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
61?) 47 -7� 57
1 ��Owner � � �� Address ��'������
('ontra�tor �'�'—�'►'t� Address ����� �-t�'�-� «' �
City License No. State License No.
REMARKS ANll SPECIAL CONDITIONS
YERMIT TYPE AND FEE: NEW ❑ ADDITION ❑ REPAIR
Inside Plwnbin�; ( �� fixtur�s ) Fee $ On Site Septic System Fee $
Water Meter (Si�e ) Fee $ Water Well Fee $ �� ' ��
Meter �#
Mechanical Equipment Fee $
12emote#
Municipal Water Connection Fee $ Moving/Lifting Buildings Fee $
�Copper Q Land Alteration (Excavation, Fee $
Grading, Filling, etc.)
Municipal Sewcr Com��ction Fee $
❑ PVC ❑ C:ast n Other: Fee $
MWCC SAC Cliargc Fee $ After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
Tlie undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information, ��
Lercns, conditions or requirements written above. The
undersigned understands and a�ees under penalty of law State Surcharge: Fee �
that this permit is stricUy limited in scope to the work,
activitY or improvement specified; that this Permit does � ��
not �rant any authority to do work or activities requiring Total Amount Paid to City Fee � "
sepazate permit approvals; and that this permit does not
�ant 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 depaztment regulations, and shall be T�11S p�T7Tllt 1S IIOt valid U11t11 t�lE', pCOpeI' tef', 1S ]�dld i1T11.�
subiect to inspection, approval or reiection bv the c;ty. it is approved by an authorized City Official.
Whenever so ordered, the undersigned agrees to correct
any work found to be u� violation of the conditions of
this permit.
Signature of A licant � Sign t re of City Official �� "
� .�..O/�/�,� �—(..�,.-- � � �nV"�,� �J �� ��
Code:White--I ile Copy Canazy-Inspector's Copy Pink-I inance Copy Gold-Applicant's Receipt