HomeMy WebLinkAbout1989-7596 - well GENERAL PER1elIIT CITYPERMITNO. _—"�59� ,
CITY OF ORONO Dat� �- �� ���
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357
Owner ��TC� ���N Address �Ss e��T v i �w
Contractor S T'�/�iv5 �Ec..L Address (��Y�JJ t�[c;h�,.ti�N„ i� (.v �APG� ,r����U
City License No. ��S� State License No.
RF;MARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing( # fixtures ) Fee $ On Site Septic System Fee �
Water Meter(Size ) Fee $ Water Well Fee $ , «���
Meter #
Mechanical Equipment Fee $
Remote#
Mtxnicipal Water Connection Fee $ Moving/Lifting Buildings Fee $
❑Copper Q Land Alteration (Excavation, Fee $
Grading, Filling, etc.)
Municipal Sewer Connection Fee $
❑ PVC ❑ Cast n Other: Fee $
MWCC SAC Charge 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
undersisned understands and a�ees under penalty of law State Surcharge: Fee $- "�f/
that this permit is strictly limited in scope to the work,
activity or irnprovement specified; that this permit does ��
not grant any authority to do wark or activities requiring Total Amount Paid to City Fee $ �Cl�.��i—�
sepazate permit approvals; and that this permit does noL
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 This permit is not valid UIltll t112 pl'Opel' fee 1S pold a11C1
subiect to inspection, approval or rejection by the c;cy. it is approved by an authorized City Official.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signature of Applicant �---� Signature of City Official
n � � ��. S��-�.� �C�,
Code:White–File Copy Canary–Inspectur's Copy Pink–Finance Copy Gold–Applicant's Receipt
DATE TIME
CITY OF ORONO CALLED-IN
INSPECTION NOTICE SCHEDUI.ED ���7 2 ;3C�
PERMIT NO. '7�R�v connP�ErE� �'��
ADDRESS ��� ��-'������
OWNER .,aY� �'��1` CONTR. �'�v���
TELEPHONE NO.
❑ FOOTING p PLUMBING RI ❑ SITE INSPECTION
❑ FRAMING ❑ MECHANICAL ❑ EXCAV./GRADING/FILLING
� ❑ INSULATION ❑ WATER HOOKUP ❑ LAKESHORE/WETLANDS
� ❑ WALL BD. ❑ METER SET/TURN ON ❑ LICENSING
W ❑ FINAL ❑ SEWER HOOKUP ❑ COMPLAINT
� ❑ PROGRESS ❑ SEPTIC INSTALL. ❑ FOLLOW-UP
� ❑ DEMOL. ❑ EPTIC MAINT. ❑ SEPTIC FINAL
Q ❑ FIRE PREV. �WELL TEST PUMP ❑ FIREPLACE/WOOD BURNER
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QW WORK SATISFACTORY: PROCEED ❑PHOTO TAKEN
❑ ORRECT WORK& PROCEED
V ❑ CORRECT WORK. CALL FOR REINSPECTION BEFORE COVERING
❑CORRECT UNSAFE CONDITION WITHIN HOURS. INSPECTOR WILL RETURN.
❑STOP ORDER POSTED. CALL INSPECTOR.
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
call for the next inspectio ho rs in advance.
Owner/Contr. on sit �Z�
Inspector !�l �
473-7357
White Copy/Inspector's e Gold Copy/Site Notice