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GENERAL PERMIT <br />Crnl OF ORONO <br />P.O. BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner <br />Contractor bu <br />City License No. 1�2_ _ <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE -- <br />Inside Plumbing Ofixtures <br />Water Meter (Size —) <br />Meter u <br />Remmte # <br />Municipal Water ( onnection <br />O Copper O <br />Municipal Sewer Connection <br />❑ PVC O Cast O <br />NiWCC SAC Charge <br />On Site Spetic System <br />ACKNOWLEDGEMENT <br />NEW <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Tle unkrivrkd herrM acknawkdgt� mrrpt of !ht% limited permit, <br />tnitrdtrtg awrrur%:c it( all 4xvial information term, t+wadruortt ,r <br />fewarementt wnurn ahtnc TV urxkrvgrrctl undrr%und, and igrre` <br />utxkr rrnah� of bw that this permit n.tnidt Itmtcd in score to tux u,wk <br />hYnn% =w omrwowmrm cprall d. that tht% rrrmtl due• no( grant ant <br />autM nh k,tdt= wtwk tx uttrurrt rctpmnrtg elnrat lrrmtt aplwonah anti <br />thattht.permndoa�nwgramatudw=ntyk+t,,,lateany( o <br />,NthrLln7 or %wk- La -A. rule tw regulatu,It All Aork hall he done in irk r <br />tt,mrrllawt: Ntth _'t Co tn)tnant.. MakLrtg ttxk!% and in health <br />tlrpnnmrnt rcgulautm.. and %lull he ,trhrtvt to tn.rrctttm Iplwtnal it <br />rr)cowm ht tlx Uit% Nhen•trr w, ordered. the unkfr Bred agrtr- to <br />ctwm't ant work found k, he to to L9utm of the trmdttkarta of his permit <br />I Signature of Applicant <br />CITY PERMIT N? 9103 <br />77MY 7 <br />Date _ <br />Address � <br />—LLI�i_--f�� <br />/�� <br />Address 115�LO ,All r!%!S _ <br />City ,� l,C /� ✓Pr- V�II� <br />❑ ADDITION ❑ REPAIR <br />Water Well <br />Mechanical Equipment <br />Fireplace/Wood Stove <br />Moi,ing/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading. Filling, etc.) <br />Design Review <br />Fire <br />Sprinkler System (Fire) <br />Other. <br />-Xfter-the-fact Investigation <br />TOTAL <br />State Surcharge <br />Total Amount Paid to City <br />O REMODEL <br />Fee S S�v V <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fa, S <br />Fee S <br />Fee S <br />Fee S _ <br />Fee S <br />Fee $ <br />--7 <br />Fee S <br />This permit is not salid until the properfm ii, pale and it is approved <br />bN an authorized City Offirial. <br />Sipria;LVe of City %OfFi(.ial r <br />(Ctxk White I Jr Corn <br />:'anon Impttuu't ('ups <br />Pink- Finswe Copy <br />Gold---AppMce0% RAtt^t <br />