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GENERAL PERMIT <br />.00 -- <br />CITY PERMIT NO. --70411 <br />CITY OF ORONO-2y-83 <br />Bate <br />P.O BOX 66 <br />CRYSTAL BAY, MINNESOI A 55323 <br />(U-12) 473-7357 <br />Owner , - f��IVST. <br />Address <br />Contractor � t �� ._ _ <br />Address %Ii-Y.4_ _AVIV> - /WMV_9 i -.-_ <br />City License No. - — -------_-_._— <br />State License No. —_----_---_ <br />REMARKS AND SPECIAL CONDITIONS <br />e"s <br />its, <br />or s �r-C -- - <br />PERMIT TYPE A.Nu ri:E: XNFW ❑ AUDITION ❑ REPAIR <br />Inside Plumbing( M fixtures_,_) Fee S <br />On Site Septic System Fre y�.1� _ <br />Water Meh.r (Size ) !-ee S <br />Water Well Fee <br />Meter #---_-_--- --- .— <br />Mechanical Equipment Fir S -- <br />Remote <br />Municipal Water Connrttic.. Fir S <br />Moving/Lifting Buildings Fee S _ <br />UCepper Q._— —____ <br />L;�-td Alteration (Excavation, Fee S- —____ <br />Grading, Filling, etc.) <br />Municipal Sewer C'onnccrion Fee 3 <br />_ <br />❑ Pvc [j (atit Q __-.- . — <br />Other: Fee S -- <br />MWCC SAC Charge Fee S <br />After-tite-f-act Investigation Fee S <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of all special information, <br />terms, conditions or requirtmenu written abo•e. 1t. <br />undersigned understands and apeea under penalty of Is - <br />that this permit Is stricuy limited in scope to is work, <br />activity or improvement .pecirledi that this to .nit does <br />not pant any authority to do work or acUcitie, requiring <br />separate permit approvals, and that this permit does not <br />Quit authority to viulste io-Y provision of any City <br />ordinaaee or State law, rule or regulation. Ali work shall be <br />dune in strict compliance wi•.h all Cit) urdl,.ancea, budding <br />codes andf.o health department regulnuons, and @ball be <br />sublecI to inspection, approval .w relecuo.: by the City. <br />neve- t Wha(i ordered. the undersigned agrees to correct <br />any wot,t found to be in .lulati..n of the condli.�ns of <br />We pern.it. <br />Signature ul' Ap, licant <br />TO I -AL <br />State Surcharge Fee S <br />Total Amount Paid to City Fee S 3 <br />'This pennit is not %slid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature ofCity Official <br />(.oar Wkite t ile Copy — -- Canar) ln>ractol'! ('op) <br />Pink 1 inance Cop) Gott! iipplicalnt'<. Receipt <br />