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GENERAL PERMIT <br />CITY OF ORONO <br />CITY PERMIT N? 8972 <br />P.O. BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />�� (612) 473-7357 <br />Owner C— •cirgs E S <br />Contractor e w <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />Date 4-ZI — 97 <br />Address _35,3 3 Cr y ss.-M L -PL <br />Addns 353� T�l,_ �L <br />City <br />J <br />_ �� + • • <br />'• vat.' _ ■•lam • �� <br />PERMIT TYPE AND FEE. - <br />Inside Plumbing (#!fixtures ) <br />Water Meter (Size ) <br />Meter # <br />Remote a _ <br />Municipal Water Connection <br />❑ Copper O <br />Municipal Sewer Connection <br />O PVC ❑ Cast ❑ <br />MWCC SAC Charge <br />On Site Spetic Svstem <br />ACKNOWLEDGEMENT <br />❑ NEW ❑ ADDITION ❑ REPAIR <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />The undersigned hemby acknowkditm rttiript of this limited permit. <br />including atu-pwamv of all aprc'ial information. terms. condinnm or <br />requirements written ahow. The undersigmed urdenarwts and agrees <br />under penalty of law that this prrmn tswiuly limited in wopr to the %ork. <br />actisity or impwownwrit specified: that this permit dons new grant any <br />authority todo work o r aciisitics requiring seperatc permit appnnah: anJ <br />that this prrmu dons not gmi authority to sidar any p rosision of any City <br />owdiromr or Stale law, rule or regulation. All work shall to dome in strict <br />oarmpliame with ap City omlirongec, building ctides and/or health <br />department regulation+, and shall be at4xt to impection, approsul or <br />rcjmtion by the City. When ewr +o ordered, the undersigned agrees nr <br />comIct an s work f6uml to he in siolation of the conditions of this permit. <br />Signature of Applicant <br />Water Well <br />Mechanical Equipment <br />Fireplace/Wood Stove <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Design Review <br />Fire <br />Sprinkler System (Fire) <br />Other. <br />After -the -fact Investigation <br />TOTAL <br />❑ REMODEL <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee SO•C%V <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />State Surcharge: Fee $ So <br />'mac <br />Total Amount Paid to City Fee S SD <br />This permit is not valid until the proper fee is paid and it is approved <br />by an authorized City Official. <br />City <br />Code: White File Copy Canary Inspcoox s Copy Pin{ Finantr Copy Cmld- - Applicant's %xviptt <br />