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<br /> i��� ,.��,,;-���� {;,, - . CITY PERMIT NO. 6717(a ,.
<br /> ' =ir:;GEN�RAL P�RMIT � �
<br /> z����rCITy p� ORONO Date 6-�3 "�
<br /> �'�"#� � P.O.BOX 66
<br /> �^•�.,� . � �. �.. � .
<br /> �"� '�. CRYSTAL BAY,MINNESOTA 55323
<br /> �,'j:; (612)473-7357 � �
<br /> �,L, � `�' I ` /�� / � � /•
<br /> ��.� . , �f
<br /> ,�F ,, /,(/�� Qi Address
<br /> �Owner �" , � � —
<br /> /X���u�aaress
<br /> `:contra�ta�
<br /> �����:° `' State License No.
<br /> City License No. - �
<br /> ��,: � /r �
<br /> *�REMARKS AND SPECIAL CONDITIONS � P
<br /> ' � �
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<br /> ,3 � � 9 ��� s
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<br /> �.tpERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑REPAIR �
<br /> ` On Site Septic System Fee S
<br /> � �Iriside Plumbing( # fixtures ) Fee $
<br /> f';r; : . WaterWell Fee S _
<br /> "Water Meter(Size ) Fee $
<br /> � � � Fee� S
<br /> � ;`. �. , -Meter # Mechanical Equipment
<br /> ;��` -� ��:Remote# , Fee S
<br /> ,, � . Moving/Lifting Buildings
<br /> :>; Fee $ Fee S
<br /> �Munic�pal Water Connection
<br /> , Land Alteration(Excavation,
<br /> '� � r::[]CopPei Grading,Filling,etcJ .
<br /> =."���, ; . Fee $
<br /> Murucipal Sewer Connection p�e1: Fee S__---
<br /> � ,.
<br /> ���� ' CI PVC ❑Cast n----- c ��/� a
<br /> �i��" � Fee Ss2�s� Afterthe-fact Investigation Fee S_.—
<br /> �MWCC SAC CharBe
<br /> ���t, „ ,
<br /> s ,�4�s , _ � � � TOTAL �
<br /> .pC�CNOWLEDGEMENT
<br /> ���5�•,� . . ed hexbY acknowledtes zecdDt of Wa limiled
<br /> �',Y,,Th�uadad� �ceeDtance ot dl �D�d� intorm�tlon. Fee ��---
<br /> ,� ,.; vamis, m�Ya�s 'r�• State Surcharge:
<br /> �'.`y 2 Fqmu.�'emdttions or :eV�menL wdttea ��•
<br /> �.undeestands u►d �y undee P�� of Lw
<br /> h� Er'taa:J mis vernie b .aicHr u.ni+ea 9a .00De to 11'ii ao: tY Fee S ��
<br /> � .;r :��a`� ��,�m�„t ,�n�a: ri►•s mi. v� Total Amount Paid to Ci ---�—
<br /> w :'-:w�%ad'R�uC �n7 autAoYlb to do wark or aetivltles reQui:lnt
<br /> >Ny�y ps�mit aVOrovds: md that t63s V�nnit doe� not
<br /> �� t���p{ p�fLWitY'-to vlolate �nY VY�oa of �nY CItY
<br /> ,�,� �� o=g��k���a o=re�ulatloa.All work�hvl be .I.h� pe�it is not valid until the proper fee is pa1
<br /> ' �r "°dow io afsleL compltmce with all Cit9 o:dfnmeas,buildlnt
<br /> ''�';eoda md/os Walth.dtDarpnent ret�tloas. �nd shtll be
<br /> �g�„�pyrov�t � rf��n�� br �Q �'t''• it is approved by an authorized City Official.
<br /> .� �' ' .�'wtbl�ct to �aed. ths undsid��d �� � coaeat
<br /> , N/hanewi_w vtoLtlon of tl�e aoadltloas of
<br /> �'� � anY woek fouttd W be 1n
<br /> �,�,�. fhts Deemli
<br /> '' ' Sign of City Official
<br /> Si ature of A plicant �S
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<br /> 4 ' pink-1•'imnce CopY �%�d—APP�t s Reoeipt
<br /> s h' Code:Whtte-1'i!e CopY CanuY l�►sPector:CopY _.
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<br /> ,x•. � ..,_ ` '�,A�*.��y,ti��'r "+��3"!� t6 <'�;+' '�`.- t 3+ _
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<br /> e� ��t 4K 4�..;�`I t�*,`�° y� x,`l �.<<-�
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