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GENERAL PERMIT CITYPERMITNO. �858 <br /> CITY OF ORONO 3_� �_ ,� �--- <br /> P.O.BOX 66 Date <br /> CRYS AL BAY, MINNESOTA 55323 <br /> (612)47 - 357 <br /> � <br /> Owner -��Y�-' Address /"�d /e `e <br /> � (,j_, � <br /> Contractor `Q.� Address �� I I Ul9 1� ��Q ��' (��n- <br /> City License No. �� �� State License No. <br /> REMAR AND SPECIAL CONDITIONS <br /> �� . i�..��� �?-�� ���e � ��.a-��. <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION EPAIR <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 � 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, �O <br /> terms, conditions ox requirements written above. The <br /> undersigned understands and a�ees under penalty of law State Surcharge: Fee $ ' <br /> that this permit is stricUy limited in scope to the work, _ _^ <br /> activity or irnprovement specified; that this permit does ��`j <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 and/or health department regulations, �a �eu ne This permit is not valid until the proper fee is paid and <br /> subiect to inspection, approval or reiection by the c�tY. it is approved by an authorized City Official. <br /> Whenever so ordered, the undersigned agrees to conect <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Signatur �rof A�plic nt Signat ;�of City Official / <br /> � � � Q� <br /> l'�f�, ,,�`.�� // . `�' � � _"_�--- I ,�0 �-1� � — <br /> ..f��� <br /> � <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—ApplicanYs Receipt <br />