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ANER <br />AL PERMIT clTYPERMITNO. 8212 <br />CITY OF ORONO Date <br />1' O.BOX 60 <br />cKYSTAL BAN'. MINNESOTA 5533 <br />16121373-7)'j / <br />Owner <br />(L Address l �l <br />Address <br />('ontra741±; <br />tor <br />City License No. <br />/",State License No. <br />tT� <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: 10 N1 w ❑ %Ulifl IUB ❑ REPAIR <br />I11.1de Plumbing 4fl-miures-_) Fee 5 _ - -- <br />NiterMeter (Site_) Fee S — — <br />Sleter! <br />Remole A <br />%lunicgtal Water Connection Fee S _ — — <br />❑Coplkr n <br />Municipal Scwer Con ection Fee S —'-- <br />O Pvc yCast ❑_ <br />MWCC SAC Charge <br />///��� Fee S . <br />on Site Septi System <br />ACKNOWLEDGEMENT <br />Fee S <br />The und-entm.d h. -b, •,tnor t.dp- ren IV of thl-hmtlyd <br />p,,11. tndudln, •«rP Wcr of aU W-"' Inlutm atlon. <br />cundwons or requirements rnttrn abme. Th- <br />undrrrtU+e4 undo mond- and •pee- nde, P"011 - .-I ta. <br />that this prrwtll 1. -tU <br />n<. u meted In ec.,P- to th ..,r►. <br />acUNb ,u lm Pro.rnt-nt -Pra11Md. that this permat d— <br />A Grant an- •uthunn In d„ .rsk tit -ctr-tUe- r.qulnna <br />at &hit <br />pant wNunlr to <br />•t ui-lr man �P-a son .1 " Cl,, <br />aU b• <br />urdlnu rr ret Sims Ir., rule ,, r-Nl-Uun. AU work .n <br />door In -tn<t .umpUan.r rich as AlplaV art.�l <br />atld h.0 b" <br /><ne.- .red: nr I-ealth deoartm- . <br />tubi.,( to k--PKUon. WPrmal w nMe.rlNcumct <br />th'brn..er w otdrted, the und-signed aa--- <br />am .,Wk loured u- b. In j.a.u— til the cnndlllnn- of <br />thio 10armit <br />Signature of Applicant <br />Fee S --1 <br />Equipment Fee S —1 <br />wing Lifting Buildint<s <br />nd Alteration (Excavation. <br />Grading. Filling. etc.) <br />System (Fire) <br />fter-the-fact lnvestigation <br />TOTAL <br />Fee S <br />Fee S - <br />Fee S�— <br />Fee S�— <br />Fee S — <br />Fee S <br />State Surcharge: Fee S — <br />Total Amount Paid to City rce yz= <br />This pennit is not valid until :he proper fee is paid ani <br />it is approved by an authorized City Official. <br />Signatul� City <br />Cd.k white- t ne C/y>> Canary' '. i Iy Pink -F mance COPY <br />cold- Appacal VI R.atpl <br />