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GENERAL PERMIT CITY PERMIT N� 8 6 8 4 <br /> CITY OF ORONO <br /> P.O. BOX 66 Date J�� � � <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner //� �-�1 � Address � � ��I `�� �2 � <br /> Contractor �SZ.X_Sl ���'� - Address �� � � y' �rS �� " � T <br /> City License No. �"' � �� City � C� �,S� C �� <br /> REMARKS AND SPECIAL CONDITIONS <br /> ,��� ��c <br /> 14 <br /> � <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 $ ��5`� <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 /> MW CC SAC Charge Fee $ � -� <br /> Other:���--��'� - �"''�-- Fee $ /�� <br /> On Site Spetic System Fee $ <br /> After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> State Surcharge: Fee $ � � <br /> The undersigned hereby acknowledges receipt of this limited permit, ��,. � <br /> including acceptance of all special information, terms, conditions or Total Amount Paid to City F88 $ <br /> reqwremen[s wntten above. ThC undersigned understands and agrees <br /> under penalty of law tha[this permit is stricdy limited in scope to[he work, <br /> activity or improvement specified; that this permit dces not grant any <br /> authority rodo work or activities reyuiring separate permit approvals:and <br /> that[his permit does notgrantauthority to violate any provision of any City <br /> ordinance or State law,rule or regulation.All work shall be done in strict This permit is not valid until the proper fee is paid and it is approved <br /> compliance with all City ordinances, building codes and/or health <br /> department regulations,and shall be subject to inspection,approval or by an authorized City Ot�icial. <br /> rejection by the City. Whenever so ordered,the undersigned agrees ro <br /> correct anv work found to be in violation of the conditions of this permit. <br /> Signature of Applicant <br /> Signature of �ty Official ,' <br /> ����G�--�-�/--��� _ c'�-�--�.� -�--� <br /> , <br /> Code: White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold Applicant's Receipt <br />