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GENERAL PERMIT CITY PERMIT NO. 79855 <br />CITY OF ORONO Date � <br />7_,_PS <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner /Q moo" ew— saNk� Address tale, 14,. D <br />--) <br />Contrai,tor -�'0ti --s;.�0C34 Address / 21l A <br />City License No. State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: YJNEW ❑ ADDITION ❑ REPAIR 04 <br />Inside Plumbing (#fixtures_) Fee S Water Well Fee S 3D <br />Water Meter (Size—) <br />Meter # <br />Remote # <br />Municipal Water Connection <br />❑Copper <br />Municipal Sewer Connection <br />Fee S Mechanical Equipment <br />Moving /Lifting Buildings <br />Fee $___ Land Alteration (Excavation, <br />Grading. Filling, etc.) <br />Fee S __ ` It ire <br />❑ PVC ❑ Cast Q— <br />MWCC- SAC Charge Fee S . --_-- <br />� On Site Septic System <br />ACKNOWLEDGEMENT <br />kler System (Fire) <br />her: <br />Fee S (After -the -fact Investigation <br />The undersipted hereby acknowledges receipt of this limited <br />perm IL including acceptance of an special lnformaaon. <br />terms. conditions or requirements wdttee above. The <br />undersped us&can& sod .pees under penalty of low <br />that this permit is strietb nrMtad to scope to the wart. <br />n Uvlty or Improvement speeinsd. that this permit don <br />nal pool any authority to do work or activities repuirieg <br />separate permit approvals. and that this perrnll don not <br />grant authority to violate any provision or any C/ty <br />ordinance or State law. rule or regulation. An work shall be <br />does in strict eampnanco with all City ordinances. building <br />codes and/or health depastmeal regulation, and tall be <br />subject to htepeetios. apprrrval or rebetoe M the City. <br />Whenever so ordered. the undersigned agrees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Signature of Applicant <br />TOTAL <br />Fee S <br />Fee S <br />Fee S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />SD <br />State Surcharge: Fee S <br />S� <br />Total Amount Paid to City Fee S <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signal Ci Official <br />AV <br />Code: white -He Copy Canary -Ingmeor s Copy Pink -Finance Copy Gold -Applicant'. Receipt <br />