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GENERAL PERMIT CITY PERMIT No��.�,..,s o g� <br /> . n � . <br /> CITY OF ORONO '� ����� ` <br /> Po.. <br /> ,� `,�� '.�"''s��:�. <br /> ��,, � <br /> �� / � <br /> P.O. BOX 66 Date '=�'� ��C= �����_ <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> _ , � l� <br /> Owner ! r ^ ' c Address ��L�� ���' � � <br /> / j/ �J��_ /�� � /J <br /> �,P_ �-��Y��.L�-C,L �Tk ���.�� Address���� (.�,� ./�� C'�S ����CJC <br /> Contractor � <br /> LL` �/ <br /> City License No. ��� City � �/�) � �-% � � 7 �:%-� y" �� <br /> REMARKS AND SPECIAL CONDITIONS <br /> � � � ,(_� i �-��'� ,`� <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 $ -��� 'Ud <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 /> MWCC SAC Charge Fee $ - �, <br /> Other.��� -�-��— Fee $ ���J�J <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, ,�� C � <br /> including acceptance of all special information, terms, conditions or Total Amount Paid to City Fee $`'� <br /> requirements written above. The undersigned understands and agre� <br /> under penalty of law that this permit is stnctly limited in scope to the work, <br /> activity or improvement specified; [hat this pertnit dces not grant any ,.y <br /> authoritytodoworkoractivi[iesrequiringseparatepermitapprovals;and ���r7� � � / <br /> that this permit does notgrant authority to violate any provision ofany Ciry <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 Of�ieial. <br /> rejection by the City.Whenever so ordered.the undersigned agrees to <br /> corrcct any work found to be in violation of the conditions of this permit. <br /> Signature of Applicant <br /> - Signature of City fficial <br /> -� <br /> �_�Yl�a�c�l .�n� �--�-f�-m � C����._� c�� <br /> Code: White File Copy Canary—Inspector's Copy Pink Finance Copy Gold—ApplicanPs Receip[ <br />