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GENERAL PERMIT CITY PERMIT N� 8 s�'� <br /> CITY OF ORONO <br /> P.O. BOX 66 Date �" / � �) �' <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> � .� <br /> Owner ,�� � • -.� -�_. Address �-v ��_�� ` _��(� ��%1.. <br /> „ <br /> Contractor �� � ���" `�� t � ���'��� Address � � �`� ��� � 1���-� �� <br /> City License No. /'r � � / City � �� �� ��`�� � <br /> J � -� <br /> REMARKS AND SPECIAL CONDITIONS <br /> ( j� '���1�'1��C� c�o �— r���� _ Q �.�, � <br /> h <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 $ ��� �'Z% <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 (Frre) Fee $ <br /> MWCC SAC Charge Fee $ ,�!� i,. �- , <br /> Other: ����--' t:�- Fee $ �- <br /> On Site Spetic System Fee $ <br /> After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL ,� <br /> State Surcharge: Fee $ f�C � <br /> Thc undersigned hereby acknowledges receipt of this limited permi[. �%'� '"") ��---} � <br /> includin� acceptance of ail special information, terms, conditions or Z'O� E�ITIOUrit P'd1C� CO Clty F0e $ L� /: �-' �� <br /> reyuirements written above. The undersigned understands and agrees <br /> under penalry of law that this permit is strictlylimited in scope to the work, <br /> activiry or improvement specified: tha[ this permit dces not grant any <br /> authority[o do work or activioes requinng eparate permit approvals;and <br /> that ihis permit dces notgrant authority to viola[e anV provision ofany City <br /> ordinance or State law,rule or regulation.All work shall be do�e in strict This permit is not valid until the proper fee is paid and it is approved <br /> compliance with all Ciry ordinances, building codes and/or health <br /> department regulations,and shall be subject to inspection,approval or by an authorized Ciry Offieial. <br /> rejection by the City. Whenever so ordered,the undersigned agrees to <br /> correct any work found to be in viclation of the conditions of this permit. <br /> Signature of Applicant <br /> � Signat,ure�City Official j <br /> .�7�!'���� ���--- _ --� �. — � � - �y1. � <br /> Code: White—File Copy Canary—Inspector's Copy Pink Finance Copy Gold—ApplicanPs Receipt <br />