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GENERAL PERMIT CITY PERMIT No s o�o <br /> CITY OF ORONO <br /> P.O. BOX 66 Date <br /> � � �s"-�'� <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> � / ,�� <br /> Owmer �U ►'G� o r� � ��.� Address 1 7 �� �G�C%� �.c�✓' /''u.✓l� �� <br /> i <br /> Contractor �✓(� �� w � � � Address ..7��0 �Y��ry' '�'`���� <br /> City License No. � � 1 City � ���S , CC Y� f��/� <br /> ► <br /> REMARKS AND SPECIAL CONDITIONS <br /> l '�i� n�� �b. co c.� l3 i� <br /> I - � /�� , �►� (�.���� ;� �.� <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR �{REMODEL <br /> Inside Plumbing (#fixtures ) Fee $ Water Well Fee $ <br /> Water Meter(Size ) Fee $ Mechanical Equipment Fee $ J�d•�v <br /> Meter# Fireplace/Wood Stove Fee $ <br /> Remote# Moving/Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ Land Alteration (Excavation, <br /> ❑ Copper ❑ Grading, Filling, etc.) Fee $ <br /> Design Review Fee $ <br /> Municipal Sewer Connection Fee $ <br /> Fire Fee $ <br /> ❑ PVC ❑ Cast ❑ <br /> Sprinkler System (Fire) . Fee $ <br /> MWCC SAC Charge Fee $ � <br /> Other:����-�= --� f`-� Fee $ � ,5 �., <br /> On Site Spetic System Fee $ <br /> After-the-fact Investigation Fee $ <br /> ACKNOW LEDGEMENT TOTAL <br /> . ��l <br /> State Surcharge: Fee $ <br /> The undersigned herebc acknowledges receipt of this limited permit. �y'�!� <br /> including aceeptance of all special information, terms, conditions or 1'OL1� E�Il]OUrit P'dlCl t0 Clty Fe8 $ <br /> or� <br /> reyuirements writren above. The undersigned understands and agrees <br /> under penalty of law that this permit is strictly limiwd in scope to the work, � <br /> � <br /> authoritytodoworkoractivitiesreyuiringseparau permitapprovalsamd <br /> that this permit dces not grant authorih�[o viola[c any pro��sion of any City <br /> �,�d�na�«o�sr��e idH.��ie o�re��ia�;o�.Au�o�k snau bc do���n s�dc� This permit is not valid until the proper fee is paid and it is approved <br /> compliance with all City ordinances, building cocJes and/or health <br /> department regulations,and shall be subject to inspection,approval or by an aUt110f1zeC� Clty��1C111. <br /> rejection by[he City. Whenecer so ordered,the undersigned agrees to <br /> correct am w�ork found ro be in violation of the conditions of this permit. <br /> Signature of Applicant <br /> . . Signature of City icial <br /> ,�'� ��C'-(.,c—� .�f'/J�/ �-�, - '�.,, c2. .�'� �t�. <br /> Codc White File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />