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GENERAL PERMIT CITY PERMIT NO. 8200 <br />CITY OF ORONO 1-� <br />P.O.BOX (10 Date <br />CRYSTAL BAY. MINNESOTA 55323 <br />(612)473-7357 <br />Owner Address �a �� i7rinar Sfr <br />Contractor _ �-. Address <br />r <br />City License No. State License No. <br />REMARKS AND SPECIAL CONDITIONS__ I <br />PERMIT TYPE AND FEE <br />Inside Plumbing (P. fixture._ ) <br />Water Meter (Sin _1 <br />Meler # <br />Remote i' - <br />❑ NFW ❑ ADDITION ❑ REPAIR <br />Fee S <br />Well <br />Fee S ____ ---- IMechinicil Equipment <br />Municipal <br />Municipal Water Connection Fee <br />� <br />❑Copper J <br />Municipal Sctver Connection Fee S <br />V(' ❑('ast <br />MWCC SAC Charge. Fee S <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />Fcc <br />1he undrrsiosed hereby arknowleders mcelpl of this Urnited <br />permit. Includutg acceptance of as special Information, <br />Arms, Conditions or requirements written &b*. The <br />uruLrslor <br />aned understands and &pees under penalty of law <br />that this permit Is strictly Whited in scope to the work, <br />activity as improyemand <br />t speathis ed: that permit doe. <br />not grant any authority to do work or activities requiring <br />separate permit approvals: and that this Permit does not <br />pant authority to .tolste any provision of any city <br />ordinance as State law, rule or regulation. Aa work shwa be <br />dome In strict comelianee with as city ordinances, buddins <br />codes and/or health department regulations, and Was be <br />wrbleet to inspection. approval or rection by the city. <br />NTenewr w ordered, the undersigned agrees to correct <br />any work found to be in Nolation of the conditions of <br />this permit. <br />Signature of Applicant / <br />J d/ <br />'.Moving /Lining Buildings <br />Land Alteration (Excavation. <br />Grading. Filling. etc.) <br />Fire <br />Fee <br />S <br />Fee <br />S <br />Fee <br />$ <br />Fee <br />S <br />Fee <br />S <br />ler System (Fire) Fee S <br />Fee S <br />fter-the-fact Investigation Fee S <br />TOTAL <br />State Surcharge: Fee S s L <br />Total Amount Paid to City Fee S W.60 <br />This pertnit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature f City Officio <br />Code. White -File Copy Callan- -Inspector's Copy Pink -I Pence Copy Gold -Applicant's Receipt <br />