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GENERAL PERMIT CITY PERMIT �� 8'7'7 8 <br /> CITY OF ORONO <br /> / \� <br /> P.O. BOX 66 Date I l � � J �' <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> 1 _Q �/ , <br /> Owner T ��(L� �S�/l Address �J�"� l-�-� � I E'.�`�: � <br /> Contractor � � � ���1'����� Address �"'��• ��� � �� <br /> City License No. `��-���� City <br /> REMARKS AND SPECIAL CONDTI'IONS <br /> �{ '� �� ���9' �"� � ��- �� <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION � REPAIR ❑ REMODEL <br /> Inside Plumbing(#fixtures ) Fee $ Water Well Fee $ <br /> Water Meter(Size ) Fee $ Mechanical Equipment Fee $ <br /> Meter# Fireplace/Wood Stove Fee $ <br /> Remote# Moving/Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ Land Alteration (Excavation, <br /> � �p�r � Grading, Filling, etc.) Fee $ <br /> Design Review Fee $ <br /> Municipal Sewer Connection Fee $ <br /> Fire Fee $ <br /> ❑ PVC ❑ Cast ❑ <br /> Sprinkler System(Fire) Fee $ <br /> MWCC SAC Charge Fee $ <br /> _` o Other: Fee $ <br /> On Site Spetic System Fee $ �'�� <br /> , After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> State Surcharge: Fee $ <br /> , ��u <br /> The undersigned hereby acknowledges receipt of this limited permit, �s <br /> including acceptance of all special information, terms, conditions or Total Amount Paid to City Fee $ '"'�' � <br /> reqwrements written above. The undersigned understands and agrees <br /> under penalty of law that this permit is strictly limited in scope to the work, /,t`J`' �.'���-/3� <br /> activity or improvement specified: that this permit dces not grant any � <br /> authority to do work or activities reyuiring separate permit approvals;and <br /> that this pertnit does not grantauthoriry to violate any provision ofany City <br /> ordinance or State law,rule or regulaoon.All work shall be done in strict This permit is not valid until the proper fee is paid and it is approved <br /> compliance with all City ordinances, building codes and/or health <br /> department regulations,and shall be subject to inspection,approval or by an authorized City Official. <br /> rejection by the City. Whenever so ordered.the undersigned agrees tc� <br /> correct any work found to be in vialation of the conditions of this permit. <br /> Signature of Applicant <br /> ��� , Signature of City Official <br /> ' �-��JY � , �, <br /> ; <br /> Code: Whi[e—File Copy Canary Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />