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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)473^357 <br />CITY PI RMIT NO. 7547 ' <br />Date <br />Owner <br />Contractor <br />Address <br />Adda’ss <br />7/^/) //Si <br />City License No <br />t^fXO A/i^ /fLfc' ilwJeC. <br />State License No___________________________________ <br />RI MARKS AND SPI CIAI. CONDITIONS <br />A-7>f/^*c y<yc> ^ /?C4</Op/i^y0____________ <br />t- At\j.? h ICOt> <7<x> -fn Oca <br />/ <br />lAJ <br />_ AgJL <br />PERMIT TYPt AND FI L: □ NEW □ ADDITION □ REPAIR <br />Inside Pluinbiny ( 0 fixtua*s.Fee S. <br />Water Meter (Si^e. <br />Meter 0__ <br />l ee S. <br />Remote # <br />Municipal Water Connection <br />D Copper n <br />Fee S. <br />Municipal Sewer Connection <br />□ PVC □ Cast Q <br />Fee S. <br />MWCC' SAC Cliai^c Fee $. <br />On Site Septic System Fee 5 nS.Cd <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />(irading. Filling, etc.) <br />Fee $. <br />Fee S <br />Fee $ <br />Fee S <br />Other:. <br />After-the-fact Investigation <br />Fee S <br />fee S <br />ACKNOWLEDGEMENT <br />Th« un«l«rticn#d hereby Avknoii!•<!•»• r«c«ipt of this lifiuud <br />i»wffnit. mcludmi arc^ptoftre of all ipactaJ infurmatton, <br />tanat, ctafidltton* or paqulramanls wntian abo%«. Th« <br />undarH^ad undrnitandi and agraat uodar panaltv of law <br />iKat tlila parmlt is ttrtctly bmitad In acopa Ui tlia work. <br />acU^ltv ur lBipf«nafiiant upaeifWd. (hal Him panmi doaa <br />nul pnwai ant aalkwcai* iu tki wugk ut akUvilMr* »*(«aArlac <br />aaparaU patwu apprwaU. and tluii thia pamit duaa not <br />grant awtlMicity lo violate any pruvtaUra oi any City <br />or stato law, ruia or raguiaUun. All work diaB ba <br />In atHct cnrapftlanre wifk all Uty urdinancaa. braiding <br />•nd/nr baallb dapavfraant regulatlona. and tkatt be <br />aablact tn tnagactUin, approval or ftiacdon by tka City. <br />Wkancya# ao ufdaaad, ika ondanigiiad agraaa to cocrcct <br />any wodi iownd to kt in vtedadon of Ika eondiUoAi uf <br />tduapagrait. <br />TOTAL <br />State Surcharge:Fee S <br />lotjl Amount Paid to City Fee S <br />This pcmiit is not valid until the proper fee is paid and <br />it is approved by an aulhonzcd C ity Offtcial. <br />Si^na&are of City Official <br />f rtd» kliitr Idal ufY f anan *» < «>!>»Iknk I inanc« ( op%( HdJ AgdUcant 'i Raccif t