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Owner <br />Contractor <br />GENERAL PERMIT <br />CITY OF ORONO <br />P.O. BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />_ (6>?) 473-7357 <br />CITY PERMIT N9 9090 <br />7-/-g'7Date <br />( d c <br />Address <br />Address <br />(o^O <br />j -------------____________ _________________________^ ~_________________ <br />City License No. "" <?0 ^ ^ y (jQ^I/ "^ V^City /^C(LJC Ps.^ _______ <br />REMARKS AND SPECIAL CONDITIONS <br />IOaII h^o^prcriH^d <br />C <br />____________ , , ____ ^ /y , ^^ ^ <br />^■HypO -hL^fJ^Ipuuv^i^^o^n^- n\(rljy^OO/ ^ 7'X 9, <br />* ^ rv\^^6“ - <br />PERMIT TYPE AND FEE; <br />Inside Plumbing (^fixtures _ <br />Witer Meter (Size___) <br />Meter#__________ <br />Remote # <br />Municipal Witer Connection <br />□ CoRjer □ ____ <br />Fee $ <br />Municipal Sewer Connection <br />□ PVC □ ast □ <br />MWCC SAC Charge <br />On Site Spetic System <br />□ ADDITION □ REPAIR <br />\^^terWen <br />Mechanical Equipment <br />Fireplace/>\bod Stove <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading. Filling, etc.) <br />Design Review <br />Rre_________________ <br />□ REMODEL <br />FeeS^^ <br />Fee $ <br />Fee $ <br />P-e S <br />Fee $ <br />Fee $72.^ <br />ACKNOWLEDGEMENT <br />The undcrapird heirt*) ackiHmlnlge^ mwpi ihn limilnl pnmii. <br />indulinfi aoxfOiKT of all mmal inl<innauon. irnm. cnniitiom <» <br />miiarnncnn »niirn ahovr Thf undrr«tmcd undcr^andt and apr<* <br />under pmaliv if la>» ihai ih» prrmil w ^iniily limttnl in <iu>pc to ihr «»orfc <br />activity or imprmrmerM sfccified: (hat ih» permit d<*i not ^nni any <br />aulhnniy to do work or activturi fnjuinnf vparaic permit approvals, and <br />that dmprntuKkiesniafianiaulhmiy loviritetrany provisuvi of anv (it\ <br />nrdinafiLT or State bw. rule <w irfulatKin All work shall he dorr in stncl <br />compfancr wnh aD Citv orUmancev huldiiv uaks and la hcakh <br />depanment itfulatianv. and shall he suhiect to tnvpectum. approval or <br />iryn-iHai hy the Citv WlrtTvet so onJered. the underv|inrd apres to <br />oormi any work found to he in vmlauon of the conhiions of this permit <br />Signature of Applicant <br />-C5 <br />'A IT./( <br />A <br />Sprinkler System (Rre) <br />Other ___________ <br />After-the-fact Investigation <br />Fcf \ <br />Fee $ <br />Fee S <br />Fee S <br />Fee $ <br />Fee S <br />TOTAL <br />State Surcharge; <br />Total Amount Riid to City <br />Fee $ / <br />Fee S //)6e t?Z) <br />This permit is not valid until the proper fee is paid and it is approved <br />by an authorized City Official. <br />S^naturpoT City OfBdal <br />Codf Whir tile Copy Canary Inspcvior's Copy Pink Finance C«'»py GoU Appiicaat's iteoe^M