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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />CITY PERMIT NO. 8227 - <br />Date— <br />227 - <br />Date ��- 10.S <br />(612)473-7357 /So. /S C' <br />"; /`3 <br />Owner R I (.,j� L�� t�1 tri 1 ll-_ J�11 Address �. <br />Contractor Address <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION <br />Inside Plumbing (#fix.ures_) Fee S <br />Water Meter (Size—) Fee S <br />Meter# <br />Remote # <br />Municipal Water Connection Fee S —_— <br />[]Copper n <br />Municipal Sewer Con ection Fee S 40' _11c, <br />❑ PVC Cast r <br />MWCC SAC Charge Fee <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />Fre S <br />The undersigned hereby acknomledps recelpt of this Welted <br />pelmlt. including a- true* of as we" information, <br />terms. conditions or requirements wdtten Wove. The <br />undershimed understands and agrees under Penalty of law <br />that title permlt In strictly limited in seope to *a wort, <br />activity or improvement specified; that this summit dras <br />not pant any authority to do wart or activities requiring <br />separete Permit approv&W and that this pemlt does not <br />pant authority to Notate spy provision of any City <br />ordinance or State taw, rule or regulation. AD work shall be <br />gape In clrict compliance with as City ordinaries, building <br />codes and/or l»alth dwaelment regulations, and WW be <br />subleet to lespsedon, approval or selection by the City. <br />wkwnavar an ordered. dw undersigned ag au to cornet <br />any work found to be in violation of the conditions of <br />this permlL <br />Signature of Applicant <br />State License No. <br />❑ REPAIR <br />iter Well <br />:chanical Equipment <br />wing /Lifting Buildings <br />nd Alteration (Excavation, <br />Grading. Fillin, tc.) <br />V <br />rinkler System (Fire) <br />Investigation <br />TOTAL <br />F: <br />� <br />Fee <br />S <br />Fee <br />S _ <br />Fee <br />S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />State Surcharge: Fee S SO <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 />Signatu of City Of tcial <br />Code. White Far Copy Canary AngrectotY Copy Mak-Finance Copy Gbid-Appacagt's Reaslpt <br />