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GENERAL PERMIT CITY PERMIT NO. 8258 <br />CITY OF ORONO Date <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner Address /,eA K2 - L; <br />Contractor Address <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE <br />Inside Plumbing (#fixtures_) <br />Water Meter (Size_) <br />Meter# <br />Remote # <br />❑ NEW ❑ ADDITION <br />Fee S <br />Fee S <br />State License No. <br />❑ REPAIR <br />ater Well <br />echanical Equipment <br />oving /Lifting Buildings <br />Fee S <br />Fee S <br />Fee S <br />Municipal Water Connection <br />Fee S <br />Land Alteration (Excavation, <br />Fee S <br />rJ <br />Grading, Filling, etc.) <br />[:]Copper <br />Municipal Sewer Connection <br />Fee S <br />Fire <br />Fee :+ <br />❑ PVC ❑Cast 0 <br />n <br />Sprinkler System (Fire) <br />Fee t <br />MWCC SAC Charge <br />Fee S <br />Other: <br />Fee $ <br />Un Site Septic SyflPm <br />Fee S <br />After -the -fact Investigation <br />Fee S <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of IN mal information. <br />terms, conditions or requirements a:Itten above. The <br />undereianed understands and agre" under penally of law <br />that this permit is strictly limited in elope to the waft, <br />activity or improvement speclned: that tyle permlt does <br />not grant any authority to do wort or activities requiring <br />separste permit worovale: and that " permit does not <br />{rent authority to violate any provision of coy qty <br />ordlnueo or State law. Me or regulation. All work shall be <br />dose in rtfet eosnptianee with as Lily ordivunae, building <br />codes andlor b@d* dgartsent regulations, and rtao be <br />subject to ha+aetlmn, approval of rejection M re qty. <br />Whenever so ordered. We undersigned agrees to correct <br />any work found to be N vioLgoa of the Conditions of <br />thu Permit. <br />Signa ure of Applicant <br />Z_W_&Z_ <br />a <br />Code: White-FIk Copy Canary-tr%Vmtor't Copy <br />TOTAL <br />State Surcharge: Fee S <br />Total Amount Paid to City Fee S 4?51_0 <br />110 <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />SI®tat Of Clty Of cial <br />Pink -Finance Copy L Gold-Appllcant•r Receipt <br />