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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)473-7357 <br />Owner <br />Contractor <br />city Ucenie No__________ <br />REMARKS AND SPEQAL CONDITIONS <br />OKSUryyJC\ iipju <br />CITY PERMIT NO.8099 <br />Date. <br />Addren Co <br />Addren ''-fyi erv~rhr£Jl A ^ <br />State License No__________________________ <br />~h) <br />PERMIT TYPE AND FEE: □ NEW □ ADDITION □ REPAIR <br />Inside Plumbing (Ifixtures <br />Water Meter (Size ) <br />-)Fee <br />Fee <br />$ <br />S_ <br />Water Well <br />Mechanical Equipment <br />Fee <br />Meter# <br />ree <br />Remote #Moving /Lifting Buildings Fee <br />Municipal Water Connection <br />rirnnner fl <br />Fee s Land Alteration (Excavation,Fee <br />Grading, Filling, etc.) <br />Municipal Sewer Connection <br />□ pVC Dcast <br />Fee f Fire Fee <br />CL <br />a---------------- <br />Sprinkler System (Fire)Fee <br />MWee SAC Chaise Fee $Other:Fee <br />On Site Septic System Fee ^7^.00After-the-fact Investigation Fee <br />ACKNOWLEDGEMENT <br />Tb« uadMlVMd h«Nby •ekaowMaM neaipt of this Uailted <br />POOBit, laeliidini ■booHobco of all «oeUl tefomattoa, <br />tonaa. coadHIoBa or naulmaoata wdnaa abovo. Tha <br />i <br />uad«tal«BOd uadatataada aad agaaa uadar panalty of law <br />that thia panalt la atriedsr ttaillad la aeopa to tha work, <br />aettvitir or haprovaaiaat ^aelWadt that dda panalt doaa <br />aoi gnuit any audiotllr to do weak or aethrltfait raqulitaf <br />aaparata pataalt approvala: aad that thla panalt doaa aot <br />■rant authoilty to vlolata aar provlaloa of aap City <br />ocdlaaaeo or SUta law, nila or ragulatloo. All wotk ahaU ba <br />doaM la aMet eompUaaea with aD atr ordlaaaoaa. buildlaf <br />eodaa mtd/or haalth dapartaaat rafulattoaa. aad aha! ba <br />auhlaot to kupaetloa, approval or tajactloa by tha aty. <br />Whaaavar ao oadaiad. tha aadaialffiad affoaa to eonoet <br />aay woah fooad to ba la vlolatloa of tha eoadltlooa of <br />thla parade <br />Signature of Applicant <br />Sr 3^^ <br />J <br />™t /I <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to Qty <br />Fee $. <br />Fe, <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized Qty Official. <br />Signature of City Ojpeial <br />Jar c^\ <br />Coda: White-FUa Copy nrnary-Inspector’(Copy Pink-Flnaiice Copy Cold-Applk»t*l Rpoelpt