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GENERAL PERMIT CITY PERMIT NO. 85520' <br />CITY OF ORONO <br />P.O.BOX 6!, Date <br />CR) S IAL BAY. MINNLSU [A 55323 <br />(b 1 _) 473-7357 <br />Owner It nQ�l I L40-('- ' Address LcilY 8r �a t, . . <br />Contractor-,�"}f rr4 r II(1Y1l=� n� Address%G%/ 1�t, .n� !Yi /$tr j <br />0 �- <br />City License No. ��� _ State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />.� AC DA i Diet ifs /4 - <br />PERMIT TYPE AND FF I 0 NFW ❑ ADDITION ❑ REPAIR <br />I Inside Plumbing lMtixturr+_! Fee S <br />Water Meter iSize—) <br />Meter 9 <br />Remote i) <br />Fee S. _ <br />Municipal Water Connection Fee <br />❑Copper ❑ <br />Municipal Sewer Connection Fee $v <br />Af PVC ❑ Cast 0_ <br />MWCC SAC Charge Fee S _ <br />oil Site Septic System <br />ACKNOW I -))UNI ENT <br />Fie 5 <br />The u;iderngned hereby selinortedaes receipt of this limited <br />precut(. ins apee <br />including acceptance rel all Information. <br />temp, conditions nr retlulnments rntten slims, The <br />undersigned undentands and stars under penalty of law <br />Matthfa permit is strictly limited In scope to the work. <br />acus Ity ew lmptusemrnt speciMd: that Nu prrrnst don <br />not grant any, authority to do work or actisitin nqulring <br />separate pertnll approvals: and that this penult does not <br />grant Wthorlty to atolate my prosldon of any Ott, <br />ordinance State ale lar. rule or regulation. All work shall be <br />done In strict complisnn with as City ordinances. building <br />codes audlor health department regulations. and shall lir <br />subivetto Inspection. approsal nr relertinn by the Lily. <br />Whenrs q so ncd,ml. the undersigned agrees to comet <br />any work Iwrnd to be in stolauon til the conditions of <br />this permit. <br />Sign of Applican! <br />Fee S <br />Equipment Fee S <br />Moving /Lifting Buildings <br />Land Alteration (Excavation. <br />Grading. Filling. etc.) <br />Fire <br />Sprinkler System (Fire) <br />Other: <br />After -the -fart Investigation <br />TOTAL <br />Fee S� <br />Fee S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />State Surcharge: Fee S -SO <br />Total Amount Paid to City Fee o <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City Official <br />t►r . T1s. i c l c <br />Cudc White -I de copy Canary Inspector't t'opy Pink I inanm Copy Gold -Applicant's ReMpt <br />