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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />OwnerA,.' <br />Contractor Duan X141 -e-1 <br />City License No. 1ma—d <br />REMARKS AND SPECIAL CONDITIONS <br />CITY PERMIT NO. 8038 <br />j <br />DateJ, 5 <br />Address ; <br />Address _ -7,/00 <br />1 <br />State License No. <br />PERMIT TYPE AND FEE: )d NEW ❑ ADDITION ❑ REPAIR <br />Inside Plumbing Ofixtures_) Fee S (Water Well Fee S <br />Water Meter (Size—) Fee S <br />Meter# <br />Remote <br />Municipal Water Connection Fee S <br />❑Copper [] <br />Municipal Sewer Connection Fee S <br />❑ PVC 0 cast rl <br />MWCC SAC Charge <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />--- IMechanical Equipment <br />Fee <br />Fee S 'Ori <br />The undersigned bereby acknowiedess receipt of this limited <br />Permit, Y eMftg accoVionce of all svecial information. <br />teras, conAliaas or requirements written above. The <br />uaderdowd vrtierstaads and agrees under penalty of law <br />tat tib pstmit is strictly limited in scope to tie work. <br />activity or improvement specified: that lib permit does <br />not pant my autiorlb to do wait or activities requiring <br />nParale vomit gvrovala: and let tib permit does not <br />grant autiority so violate ear Provision of nay qty <br />ordiaaaee or Stale law, rub or regulation. AN work siag be <br />done in strict compliance wild dl City ordinances. budding <br />codes and/or besiM deParlment regulations, and iso be <br />aibleet to btsveedoa, smovel a reiecakm by the City. <br />Miaaever so ordered. tie undersived agrees to cornet <br />my wash found b be is violation o! the conditions of <br />HW permit. <br />Signlatu of Applicant <br />Code: White -- File Copy <br />Canary Antpector's Copy <br />ing /Lifting Buildings <br />nd Alteration (Excavation, <br />Grading, Filling, etc ) <br />Fee S <br />Fee S i <br />Fee S <br />Fire Fee S__ <br />Sprinkler System (Fire) Fee S <br />er: <br />,r-tbe-fact Investigation <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S <br />Fee S <br />Fee S 60 <br />Fee $ % cj• 61 <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Si ature of City Official AO <br />Pink -Finance Copy <br />Cold -Applicant's Receipt <br />