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GENERAL PERMIT CITYPERMITNO. 819�, <br /> CITY OF ORONO <br /> P.O.BOX 66 Date_� ` -' �� <br /> CRYSTAL BAY,MINNESOTA 55323 <br /> (612) 473-7357 <br /> Owner ► ' ``�-X�-,� � �`�--��✓�a�"— Address �/ �� x`t'C?-7 CY /`—� <br /> � s� ,� /n <br /> Contractor ���-�-�.1' L�"2�� '}' Address �f'��2( � "7�P'(/�� �� /��,� • <br /> � <br /> City License No. ��� State License No. n� �O�� <br /> REMARKS AND SPECIAL CONDITIONS <br /> � '� ..._ �-y .�,.,�.� G�i '� c� <br /> � ��'� 'l�-�.k � I 1� � G-S�!� <br /> �i� K���-e.D..Q.,� �� ��� Cl� �' <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 /> 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, <br /> terms, conditions or requirements written above. The � �� <br /> undersigned understands and agrees under penalty of law State Surcharge: Fee $ <br /> that this permit is strictly limited in scope to the work, <br /> activity or improvement specified; that this permit does /�I�� <br /> not grant any suthority to do work or activities requiring Total Amount Paid to City Fee $ �•1 <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, �a �8u be 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 correct <br /> any work found to be in violation of the conditions of <br /> this pe 'L• <br /> i , <br /> Signatu o / ic t f Signature of City Official <br /> � � <br /> � <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />