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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)473-7357 <br />CITY PERMIT NO. 81l4 <br />Date <br />Owner <br />Contractor <br />City License No. <br />0 <br />ddress ^ ^ <br />ddress <br />State License No. <br />tV\+^Q^ <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: □ NEW □ ADDITION □ REPAIR <br />WeU <br />Mechanical Equipment <br />Moving ^Lifting Buildings <br />Inside Plumbing (#fixturcs __)Fee $ <br />Water Meter (Size )Fee S <br />Meter# <br />Remote # <br />Municipal Water Connection Fee $ <br />nCoDoer n <br />Municipal Sewer Connection Fee $ <br />□ pVC Ocast n <br />MWee SAC Charge Fee $ <br />On Site Septic System Fee $ <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee <br />Fee $__________ <br />Fee $__________ <br />Fee $__________ <br />Fire <br />Sprinkler System (Fire) <br />Other:_____________ <br />After-the-fact kivestigation <br />Fee $. <br />Fee $. <br />Fee $ <br />Fee S. <br />ACKNOWLEDGEMENT <br />Til* ttnilmliHR* hmby raedpt of ikIaBmItod <br />Bonait, taehidlBi aoM^teaeo of «0 portal intoimattoa, <br />toma. eoadMoM or raqulnmaata wdMon abova. Tba <br />•*oaanf«aod oadatataadi and a*oaa uadar paaaltr of law <br />tkol thia Mnlt la aMctb Itaillad fai aeopa to lha woak, <br />•etIvItT or iBpooaoaiaBt ^adHad; ttiat ttda pamlt doaa <br />not vaat aar aalMMltp to do wotk or actlvlttaa laquiilBg <br />aaparata panalt approaala: aad dut thla panalt doaa not <br />ffoat aadioiltr to dolato my paovlalon of aar aty <br />oadtaaaea or Stala law. mla or ragalatloa. AB arotk diaB ba <br />doaa la aMat aoaipllaaea with aB aty oidlaaaaaa, bulldlas <br />aodaa aad/or hoallb dapartaiaat tapidatloaa. wd diaB ba <br />aahlaat to laapaattoa. toProral or laloettoa by dia aty. <br />Wbaaaiai ao otdavad. Bm aadaaddaad agiaaa to eonaet <br />aay wotk foaad to ba la vlolatloa of tba eoadltloBa of <br />tblapaaalt. <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S. <br />Fee <br />This permit is not valid until the proper fee is paid and ^ <br />it is approved by an authorized Qty Official. <br />Sigi^re of City Ofndal <br />{i <br />1 <br />Code: White-File Copy Canafy-liupoctor’k Copy Ptak-FhiMMPCPpy Gold-AppOcMit’l Raoript u