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GENERA <br /> L PERMIT CITYPERMITNO. 82g5 <br /> CITY OF ORONO (� <br /> P.O.BOX 66 Date � `— �� (� � <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> Owner ��1��. ��_ �1��T b�� Address 1 �,��' 1(ti = , ��–� ��1� _i� <br /> Contractor Address <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> t��.--�A�t�l �'_ � 1� '_ �„1 <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 $ Land Alteration (Excavation, Fee $ <br /> � Grading, Filling, etc.) <br /> ❑Copper <br /> Municipal Sewer Connection Fee $ _ <br /> Fire Fee $ <br /> ❑ PVC ❑Cast n Sprinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $ Other: �"L�� ��G����,JU Fee $ 1 ��S <br /> On Site Septic System Fee $ After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> The undersigned hereby acknowledges receipt of this limited <br /> pexmit, including acceptance of all special information, <br /> terms, conditions or requirements written above. The r-----• <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, � <br /> activity or itnprovement specified; that this permit does �7 �I <br /> not grant anv authoritv to do work or activities rectuiring Total Amount Paid to City Fe0 $ � <br /> sepazate permit approvals; and that this permit does not <br /> �ant 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 �aior health department regulations, �a sh8u »e This permit is not valid until the proper fee is paid and <br /> �n;e�t co inspection, approval or rejection by r�e c�tY. 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 plicant Signature f Ci ici <br /> /' �� - <br /> Code:White—FIle Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />