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r <br />GENERAL PERMIT <br />CITY OF ORONO <br />an PI RMiT N9 9093 <br />PO. BOX 66 <br />CRYSTAL BAY. MINNF.SOIA 55.^23 <br />(612)473-7357 <br />Dale <br />Owner OA^')/i rl^s <br />Contractor _L U )>i )Vt.av^ V^-c. <br />Cilv Uccasc No./ ..t). I /O <br />AddaNs <br />Address <br />Cilv __^■\. (f r \ <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE <br />Inside Plumbing (^fixtures <br />Water Meter (Si/e ^fe) <br />□ NEW <br />Fee S <br />□ ADDITION □ RO’AIR <br />Meter K Cp I ^4 L <br />Fee $ <br />Remote(< C2l <br />Municipal Witer Connectiem <br />□ Copper □___________ <br />oo <br />Ftv $ <br />Municipal Sewer Connection <br />□ PVC □ Cast □ <br />MWee SAC Charge <br />On Site Spetic S\Mem <br />Fee $ <br />Fee $ <br />Fee $ <br />REMODEL <br />Water Well Fee S <br />Mechanical Lquipment Fee $ <br />Fia*place/Wixxl Sieve Fee $ <br />Moving/Lifting Buildings Fee $ <br />Land Alteration (Excavation. <br />Grading. Filling, etc.) <br />IX'sign Review <br />Fee S <br />Fee S <br />Tin*F«»f % <br />Sprinkler System (Fire)Fee $ <br />OtlxT Fm» t <br />After-the-fact invesugation Fee $ <br />r. <br />ACKNOWI EDC.FMENT TOTAL <br />State Surcharge;Fee S <br />rhe urktcTMirneil htTi*h\ aiknimkxlgr« rriTipi <»( Ihb limitril prrmii <br />irKtintif^ aixvpLiiKc «*f alt infornuiiim. terms. oHiditioiis «*t <br />rcquircmciiis \%nllen jiK*u ’ The uixkrsi^ned umkrsumK and ainco <br />under pnuilu ti law that ihisfvrmitisMrKlU limiird inwofvktihc wihK. <br />aiti\it\ <w tmprosrmml s|«\irM\i ihai ihrs prnmt divs nm gram an\ <br />aulhttnl> indttwitrk or adiuiirs m|uiring << (larali* ^fmilapprovaK .ind <br />that this fvnnifdrrsni^ grant authonlY towibie an\ prt«\ivoniiran\ (it\ <br />iifdinani.r (K Siak* law. ruk tw a*gutiiM«t .All work shall K* ikme in sim.t <br />iimiplianLr with all Citv iwiiinamvs Nalding i*Kk*s ami ih health <br />ilcpartmcTN rrgiibtions. and shall hr si#i|c\i to insptMion. .ipproxal or <br />rrpMion h\ thr* C*ils UhcncscT yt ord<*rt\I. the undsrsigncd ignvs to <br />ioriivl am work tinind ti>K* in \u4alion of the condilums o( this )<’rmit <br />Ibtal Amount l^id to City Fee $ <br />JSLoc <br /><uc H~t OS <br />This permit is not \alid until the proper Tee is paid and it is ap| <br />by an authorized City Official. <br />Signature of Applicant <br />Signature ol ( it)jQfficial . <br />t-t ^ Cj^ <br />Cikk* WhiU* hk ('opN (anar> lnspi\iof\ Cop\l*ink I markr (*op\Gold zApplK^ni's Rcvvipi