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,�ENERAL PERMIT CITYPERMITNO. 820� ' <br /> CIT� OF ORONO � �_-�� _� <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY,MINNESOTA 55323 <br /> (612) 473-7357 <br /> Owner �r ���� � Address / �.��� �_7��I 51C�1�� , <br /> Contractor � - `�� ��� Address l 7 � � < <br /> �� l_ <br /> City License No. �' � - State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> 71..1�C'=(-�C���'' C 1 I���l �. > � ��I� <br /> �t 1 I�� — 11(1 �t 1 i�'P_f_7��C�._C_C�s <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 /> c�c� <br /> Meter# <br /> Remote# Moving /Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ _ Land Alteration (Excavation, Fee $ <br /> ❑ Grading, Filling, etc.) <br /> ❑Copper <br /> Mui�icipal Sewer Connection Fee $ Fire Fee $ <br /> ❑ PVC ❑Cast n Sprinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $ Other: ��� 1 � �� Fee $ �y_ <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, �-- � <br /> terms, conditions or requirements written above. The �� <br /> undersigned understands and agrees under penalty of law State Surcharge: Fee $ � <br /> that this permit is striclly limited in scope to the work, <br /> activity or improvement specified; that this permit does �� J'i <br /> not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ ��r <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 /> codes and/or heaith department regulations, and shall be This permit is not valid until the proper fee is paid and <br /> sublect to inspection, approval or rejection by the c�cy. it is approved by an authorized City Official. <br /> Whenever so ordered, the undersigned agrees to correct <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Signature f Applic �pt Signature of City Official <br /> : .'7 , <br /> �'� � Gil.��_- �� � � �Z� �.I�, <br /> Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />