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GENERAL PERMIT CITY PEPMITNO. 8189 <br />CITY OF ORONO <br />Date <br />P.O.BOX Gti <br />_ <br />CRYSTAI. BAY. MINNESOTA 55323 <br />ia12)473-7357 <br />Owner -�t' t 1 ) t Address i` 'It t t'� <br />Contr:wtor Address <br />City License No, <br />RIAIARKS AND SPECIAL CONDITIONS <br />State License No <br />PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ Ill I -AI Ft <br />Inside Plumbing (Hixturcs_1 <br />Fee <br />5 — <br />W--Ier Metef ISlle_) <br />FCC <br />S _- --• <br />Meter <br />Fee <br />S <br />Remote ! <br />Fee <br />S <br />Municipal Water Connection <br />Fee <br />S _.- <br />❑Copper Q <br />Fee <br />S <br />%luolcipal Scher Connection <br />Fee <br />S - --- <br />❑ Pvc• ❑cast fl <br />Kher - i C <br />Fee <br />MWCC SAC Charge <br />Fee <br />S _ <br />the Site Septic System <br />Fee <br />S <br />ACKNOWLEDGEMENT <br />in• undrr.i tnrd hobby witnovtlydpr trrrlpl o this tam(laid <br />y1rm 11, tnl tudmt acerptaner nt dl spreW Inf,,w-Unn• <br />tl nn •, . ndaInns .4 "qut"mrnb rnitan obwr The <br />unJr ratnlJ un demand, and 'Qrr. under Wntltr ut lar <br />that Ila l+ W,mat a. ,tna UY bmltrd In —P. 1.. tar roti, <br />artaHatl .4 u,aptu•rmrtat we"ned. that this Dean It dura <br />-4 s,Aal ant autbontl to du calk o, ar UISU-. osal-Mnt <br />vDuatr Penna( apDtu•als. and that this Wrnaat dura nut <br />'tint au Nl.nto W 1to4M ant pl wlrlM of All CIIF <br />rtlhnanrl nr Stall tor.,uk o, "NlaUun. AU ruck daoU ba <br />J.w1, to atn,t rumph, rt%h aU fits ardan,sra— budduat <br />...,t•• and ..r heath dr `u mt "NLUuna, And Jail I. <br />wbN1t lu Uup"Um. aDD,aral .4 nhr Ion ba Wr Cth. <br />'Ahrnr.ra w 14,11"d. Nr ""'I" an.If mar— to comet <br />ant r14k found to br in 'lcdau,.n of the ronJauun, nl <br />Ihu ptrmit. <br />Signature o can <br />V y <br />u'k NTtite Ilk Cup) Canar) Ingacctot's Cup) <br />stet Well <br />Fee <br />S <br />rchmil..11 1-'111111I11Cllt <br />Fee <br />S <br />using /Lilting Buildings <br />Fee <br />S <br />and Alteration (Excavation, <br />Fee <br />S <br />Grading, Filling, etc.( <br />ire <br />Fee <br />S <br />prinkler System (Fire) <br />Fee <br />S <br />Kher - i C <br />Fee <br />S <br />fter•the•fact Irtsestigation <br />Fee <br />S <br />TOTAL <br />State surtilarge <br />Total Amount Paid to Cita <br />Fee S <br />Fee S <br />This permit is not valid until the proper fee is paid and <br />1t is approved by an authorized t'ity t)Iftcial. <br />Signatu • of City Om lal ` <br />Polk 1 inane Cup) (idd-APPOMI'S RSCd(tt <br />