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GENERAL PERMIT CITYPERMITNO. g349 � <br /> CITY OF ORONO -�/ � �,� ' , � <br /> P.O.BOX 66 Date •�'S � �� <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> �� , <br /> .,�c�,C'� 17-C�X/Yl rc�S �f" �o� �� ` (� <br /> Owner Address � �"S C'�.� �� . <br /> �� -,R ��. n <br /> Contractor ' " ?�hs r�- Address �� �' �-������� f��,'�, ��� <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> �/� �--�%P�/Ci C�� ' �-c C��G?�!�'�'r�' �-C L� <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR <br /> Inside Plumbing (#fixtures_) Fee $ Water Well Fee $ <br /> Water Meter (Size_) Fee $ Mechanical Equipment Fee $� ��`' �� <br /> Meter# <br /> Remote# Moving /Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ _ <br /> Land Alteration (Excavation, Fee $ <br /> � Grading, Filling, etc.) <br /> ❑Copper <br /> Municipal Sewer Connection Fee $ _ Fire Fee $ <br /> ❑ PVC ❑Cast n Sprinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $ Other: Fee $ <br /> On Site Septic System Fee $ After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> The undersigned hereby acknowledges receipt of this limited <br /> permit, including acceptance of all special information, C�� <br /> terms, conditions or requirements written above. The � <br /> undersigned understands and a�ees under penalty of law State Surcharge: Fee $ <br /> that this permit is strictly limited in scope to the work, i� <br /> activitY or improvement specified; that this permit does ��� ��' <br /> not grant any authority to do work or activities requiring Total Amount Paid to City Fee � <br /> sepazate permit approvals; and that this permit does not <br /> grant authority to violate any provision of any City <br /> ordinance or State law,rule or regulation. All work shall be <br /> done in strict compliance with all City ordinances, building <br /> �oaes �a�or health department regulations, �a �8u be This permit is not valid until the proper fee is paid and <br /> subiect to inspection, anproval or reiection by the c�ty. it is approved by an authorized City Official. <br /> Whenever so ordered, the undersigned a�ees to correct <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Si n ture of Appl; ant Signatur of City Off 'ial <br /> � /�� � <br /> � � :�t2>—_--� ��'�— '" � ��L'(iC� �� <br /> Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />