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GENERAL PERMIT CITYPERMI�NO. �sO� <br /> CITY OF ORONO a <br /> P.O.BOX 66 Date �/ `����. <br /> n� , <br /> CRYSTAL BAY, MINNESOTA 55323 � ' "�� a�°� <br /> (612) 473-7357 ����a� <br /> �. <br /> Owner ���� [/��/V Address ��7�.C� �X S'7- � , <br /> Contractor ��y J�,�Sb,� �X G � Address ��/N� <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> /V�� �i4 f�f l�S . ��� � .'t. S��{/��L-f."�i..�_� `T!E'��C� �,�-�N'�%�-Zl`� <br /> �rl'p t--- In�—C�lf'(��i� j^��_'�`-' �i �a� S� S F�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 /> 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: Fee $ <br /> U <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 irtformation, <br /> terms, conditions or requirements written above. The �� <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, S—� <br /> activity or irrtprovement specified; that this pertnit does �— <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 /> codes and/or health department regulations, and shall be This permit is not valid until the proper fee is paid and <br /> subiect to inspection, approval or reiection 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 plic�iar t Signature o�.�ity Official <br /> ,/ � ) � <br /> �� � <br /> .� <br /> �. <br /> Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />