HomeMy WebLinkAbout1986-8324 - well GENERAL PERMIT CITYPERMITNO. g324
CITY OF ORONO ��-`� y��-�
P.O.BOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357 �,�5'
� ��� S�?-�'� �� �,( J.
Owner ���5�1 �-C-� Address <�
„ .
Contractor ��_� "J'1 � Address �
City License Na l�� State License No.
REMARKS AND SPECIAL CONDITIONS �
�1 � ' ,� 'L �
PERMIT TYPE AND FEE: �NEW ❑ ADDITION ❑ REPAIR
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, C-�
terms, conditions or requirements written above, The i � �
undersgned understands and agrees under penalty of law State Surcharge: Fee �
that this permit is strictly limited in scope to the work,
activitY or improvement specified; that this perxnit does
not grant anY authority to do work or acti�ities requiring Total Amount Paid to City Fee $ 1 "
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 This permit is not valid until the proper fee is paid and
subiect to inspection, approval or reiection 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.
Sign� o�Ap licanT � Signatur f Ci Official
✓` ����,L�'�.��' r� � ����^-;.,
Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—ApplicanYs Receipt