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GE�I�ERAL PERMIT CITYPERMITNa 8194 <br /> C�TY OF ORONO / Q <br /> P.O.BOX 66 ' Date_ I 1� � ` U�� <br /> CRYSTAL BAY,MINNESOTA 55323 ' <br /> (612)473-7357 <br /> Owner � ���y �ro�Q-� ��i�ddress_ `� /S Qx�l�/ �� <br /> Contractor -� � � � 0�- �?�ddress C�1�7 / ��Gt �Q ��• �, <br /> City License No. State License No. ����C1 M i v1� l�� <br /> REMARKS AND SPECIAL CONDITIONS �y� <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑REPAIR <br /> Inside Plumbing(#fixture�� 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: �I�,�.G/�� Fee $ ' � <br /> On Site Septic System Fee $ After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> The under�gned hereby ackaowledaes receipt of this limited <br /> permit, including acceDtience of ell special informatton, <br /> tem►s, conditions or requirements wxitten above. The ,�tate Surcharge: Fee $ •�� <br /> undersigned underatands and aarees undex penalty of law <br /> that this Hermit is atrlctlY 1in►ited in scoDe to the work, �� '� <br /> activitq or imDrovement sDecifled; that this permit dces <br /> not grant anY authorlty to do wozk or activities reauiring Total Amount Paid to City Fee $ <br /> separate permit aBProvals; and that this permit does not <br /> �ant authorlty to violate any Drovision of �ny City <br /> ordinance or State law,xule or regulation.All work sheII be <br /> done in strlct compliance with all City ordiaances,building <br /> codes aad/or health devartment reQulattona, and shell be 'This permit is not valid until the proper fee is paid and <br /> sublect to inaDection, �proval or reiection by the c�ty. it is approved by an authorized City Official. <br /> Whenever so ordered, the undersigned a�eea to correct <br /> any work found to be in violation of the condttions of <br /> this pertnit. <br /> Signature of Applicant Signature of City Official <br /> . <br /> M c�P. �� <br /> . <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />