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GENERAL PERMIT CITY PERMIT N� 8'705 <br /> CITY OF ORONO <br /> EO. BOX 66 Date ! v � �C) � <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> � (612)473-7357 <br /> ,� <br /> Owner t��� ����-�'�-� Address �-� `-� ��� ������ �f� � � <br /> Contractor ���� C� ����" �� S _ <br /> Address ��� - <br /> City License Na � �/ City <br /> REMARKS AND SPECIAL CONDTTIONS <br /> PERMIT TYPE AND FEE�7. ❑ NEW ❑ ADDITION ❑ REPAIR ❑ REMODEL <br /> Inside Plumbing(#fixtures ) Fee $ Water Well Fee $ <br /> � <br /> Water Meter(Size� ) Fee $ i L Mechanical Equipment Fee $ <br /> Meter# � �' � � �'��� Fireplace/Wood Stove Fee $ <br /> Remote# ��� S �� �p � Moving/Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ s�� Land Alteration (Excavation, <br /> � Copper ❑ Grading, Filling, etc.) Fee $ <br /> Design Review Fee $ <br /> Municipal Sewer Connecrion 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 /> ACKNOW LEDGEMENT TOTAL <br /> State Surcharge: Fee $ ' `�� <br /> The undersigned hereby acknowledges receipt of this limited permit, �___J�� � <br /> including acceptance of all special information, tertns, conditions or Total Amount Paid to City Fee $ `�� <br /> requirements wntten above. The undersigned understands and agrees ' <br /> under penalty of law[hat this permit is strictly limited in scope[o the work, <br /> acti�ity or improvement specified; that Ihis permit dces not grant any <br /> authonty todo work oractivities requiring separate permit approvals:and <br /> that this permit does notgrantauthonty to violate anp provision of any Ciry <br /> ordinance or State law,rule or regulauon.All work shall be done i�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 Offieial. <br /> rejection by the City.Whenever so ordered,the undersigned agrees to <br /> correct any work found to be in vialation of the condi[ions of this permit. <br /> Signature of Applicant �' <br /> �.2�c / l �� Signature ,City Official � <br /> ��2��,�'-�":Y�'.��� c--- -�-7-�—� � -� <br /> Code: White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—ApplicanYs Receipt <br />