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GENERAL PERNIIT <br />CITY OF ORONO <br />11.0. BOX 66 <br />CRYSTAL BAY. MINNESOTA 55323 <br />/ (612) 473-7357 / <br />Owner <br />Contractor <br />City L.icrnse No <br />REMARKS A�►D SPECIAL CONDITIONS <br />PERMIT TYPE. AND FEE: <br />Inside Plumbing I#fxtures ) <br />Water Meter (Sire — ) <br />Meter is_— <br />Renrxe a <br />Municipal Water Connection <br />❑ Copper ❑ --- <br />Municipal Sewer Connection <br />❑ PVC ❑ Cast ❑ — <br />MWCC SAC Charge <br />On Site Spetic System <br />ACKNOWLEDGEMENT <br />NEW <br />Fee S -- <br />Fee S -__-- <br />Fee $ <br />Fee S <br />Fee S <br />Fee S <br />N- unkmlind herrh% a.knimledlin, merpt .A the, limned ry•nmt <br />,rkluhttp anrrurkv rA all ,ritual mhemauon, term rondmom .r <br />rrawrrrm•nt, wntk•n atx„r the urxk i .ad undentand, and aKrn• <br />urkk•rIknalntolawthat thi,permitr, Ind1%Itmrdm—,fiewthrwork <br />a:u,m rw rmprowntera .pyifkd, thar Ihn fierma do,, mr gram an, <br />auth,mt� wd, worti,e a,tr�nn. mdunrtg Irtrtu Ik•rmit appn„al,, and <br />that the, permit u,x, tay grant auth,um to tiNaw am pn nnmrt al am ( m <br />,NdtnOmr or Sute ktw. ruk• IN trpukvtum All wlMk ,hall hr,knk• rn ,rn't <br />.omptrarkr wuh all ( It% .mltturk11. hukdrnp ,axk•, Arad or health <br />drpanmrnt n•gnlanom mkt Dull he ,uly,ti to m,prrmm apps„al .n <br />a•pttnrn h, the ('m WKne,er - ordered, the urdrr,rprxd aero•, to <br />.Dere-t am uork ll arrxt to h• In 111'.knlOn .A the ueklmon, od the, dx•rmn <br />Signature of Applicant <br />(.xk- %k her Idr(ryn <br />CITY PERMIT N? 8853 <br />Dale <br />\ddre,c ---1 <br />❑ ADDITION ❑ REPAIR <br />_-_ Water Well <br />M <br />CCl Equipment <br />Stove <br />Moving/lifting Buildings <br />Land Alteration (Excavation, <br />Grading. Filling, etc.) <br />Design Re%iew <br />( an:u, 11"l- om” (ty% <br />Fire ----_-_-- — <br />Sprinkler SNstem (Fire) <br />Other:---__-- <br />After-the-fact Investigation <br />❑ REMODEL <br />Foe S <br />Fee S <br />Fee S <br />Fee $ <br />Fee S <br />Fee <br />Fee S _ <br />Fee S _ <br />Fee S <br />fee S <br />TOTAI. Z ) <br />State Surcharge: Fee S <br />Total Amount Paid to Cilv <br />Illis permit is not valid until the proper fee is paid and it is approved <br />by an authori/ed C•it% Official. <br />Signature of vOf�Ti_ai-a_l. <br />--- --�-ham--- <br />Pink I in:mcr ( 011% <br />12 <br />(;t)ld Xpoicant', RenPt <br />