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GENERAL PERMIT CITY PERMIT I�T� 8 S 6 6 <br /> CITY OF ORONO <br /> P.O. BOX 66 Date � <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner ��-3'��'-r} Address �`�� ! J�CJ�-�"J Pl��`�f �� �� <br /> Contractor ���E'I��� L'C'�e'/� Address %���/� /G�-/ /� <br /> City License No. ��,� City <br /> REMARKS AND SPECIAL CONDITIONS <br /> - �� _ �us�- �� `� -�/ C' � � -�� <br /> — � ��-� �'�' -E'C'or�:l <br /> ... - <br /> N���'��m��' <br /> PERMIT TYPE AND FEE: � W ❑ ADDITION ❑ REPAIR ❑ REMODEL <br /> Inside Plumbing(#fixtures ) Fee $ Water Well Fee $ �Q �� <br /> Water Meter(Size ) Fee $ Mechanical Equipment Fee $ <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 $ <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, �� �� <br /> including acceptance of all special information, terms, conditions or Total Amount Paid to City Fee $ <br /> requiremencs H-ritten above. The undersigned understands and agre� <br /> under penalty of law that this permit is stricdy limited in scope to the work, <br /> activiry or improvement specified;that this permit does not grant any <br /> authority to do work or ac[ivities requiring separate permit approvals;and <br /> that this permit does notgrantauthonry to violate any provision ofany City <br /> ordinance or Sta[e law,rule or regulaboa 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 Ciry ordinances, building codes and/or health <br /> department regulaeons,and shall be subject to inspection,approval or by an authorized Ciry Official. <br /> rejection by[he City.Whenever so ordered,the undersigned agrees to <br /> correct am work foun to be in vialation of the conditions of this permit. <br /> Signature o pplicant <br /> rv J ������-- Signature of City Offici <br /> � _ �i1�:-Q� �_G'�J'�'.� <br /> Code: White—Fi►e Copy Canary—Inspector's Copy Pink—Finance Copy Gold—ApplicanPs Receip[ <br />