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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 />CITY PERMIT NO. 8235, <br />12 — It�'-�c <br />Date , <br />Owner Slir1 Ir1t�N-r` �'•f1 Address <br />Contractor L Dr- ► ��Cl`� Address M�)0 <br />• ���X ���� <br />City License No. 1 49 State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERYj' ND t'EE: X"NEW ❑ ADDITION ❑ REPAIR <br />Inside Plt.. +'U: V s.r) Fee S IWater Weil Fee S <br />Water Meter (Sit'! Fee S <br />Meter # <br />Remote _ <br />Equipment <br />/Lifting Buildings <br />Municipal Water Connection <br />Fee S <br />Land A'teration (Excavation, <br />Fee <br />$ <br />❑Copper ❑ <br />Gralh ig, Filling, etc.) <br />Municipal Sewer Connection <br />Fc <br />_ <br />Fire -- <br />Fee <br />S <br />❑ PVC ❑Cast 0 <br />Sprinkler System (Fire) <br />Fee <br />S_ <br />MWCC SAC Charge <br />Fee S __ <br />-Other; <br />Fee <br />S <br />On Site Septic System <br />Fee S <br />After -the -fact Investigation <br />Fee <br />S <br />ACKNOWLEDGEMENT <br />TOTAL <br />The undersigned hereby arhnowledges trorlot of dde Hrrmited <br />Parnell. hwhAdllg saesptaaee of a me" lnforneadoa. <br />larnee, eatdifi M at requirements wdUm above. The <br />m adneio ed ttttderstands and apaase under Penalty of law <br />tlet thla pavan Is sUkUy Hoalted to naps to the work. <br />activity or Imp tSta an& egneif". dial " paralt does <br />ad gnat any suikorily to do work or setivid" requiring <br />seperale Paneit approvals; and that Utia senait don not <br />NMI aulkokib to vitiate any provislaw of any city <br />aedlans" or State law. rule or rogubetton. AY work shall be <br />dam in ehiet eonepban" with s^ ' ordinances. building <br />eodn and/or health d"W "ona, sad tban be <br />subhect to bmwwdom, apt don by the V. <br />Whenever so ads a . the . - agree to c :t <br />ANY wart found to be in Nolan... .,. the condition. of <br />this permit. <br />Signature ui A •iic t <br />.. I , <br />Code: White - FileCopf 0 Canary- •.spector'sCopy <br />L' <br />Statx Surcharge: Fee S. <br />Tout, Amount Paid♦z:,K'4v Fee S v`- <br />This permit is not -valid until the iar �.�xr fee is paid an4 <br />it is approved by an authorized City Offtr' ,'. <br />Signature of City Official — <br />ifs_ �-• .�%t��� �.� /? Cal.' . f� �� ` K� <br />Pink -Finance Copy Gold -Applicant's Receipt <br />