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GENERAL PERMIT <br />CITY OF ORONO <br />CITY PERMIT N? 9004 <br />P.O. BOX 66 Date <br />CRYSTAL BAY. MINNESOTA 55323 <br />(612)4773-7357 <br />Owner �(c ,1 ! , l wry t ,� 7 Address <br />Contrttctor LO Address`��cz� =� <br />City Ikense No. City fill <br />(Ale <br />. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: <br />Inside Plumbing (#fixtures _ <br />Water Meter (Sine ) <br />Meter # <br />Remote # <br />Municipal %ter Connection <br />O Copper O <br />Municipal Sewer Connection <br />O PVC C] Cast O <br />%IWCC SAC Charge <br />On Site Spetic System <br />ACKNOWLEDGEMENT <br />"\ NEW <br />Fee S <br />Fee S <br />Fee S <br />Fee $ <br />Fee S <br />Fcv S <br />'ITtt• undri,wrttd htnM ackrn,wkdgt% rtttipl of the limited permit. <br />,ndiitltr* uvovmr of all .Rtnl tnfornumm. term.. totdnu,m o, <br />r yuirrment, Antlen aM„r lire undempncd under und% and agree, <br />urrk•r pemdn A law that tht. permit n yrrllt limn d in v',Kr to the work. <br />.1101%nl% „r improtrmrrrt 'tiered: that thn Irrmn der. not grant am <br />autM�nt� to ck, work or wittlin ntyunnnp wrierar Ivrmn appro,al,. and <br />that lho prrmmikr, rw,Igramaudwvntt t„,tohk am pnoot.uxn,fait ( n1, <br />onlirtantr tx tine law. rule or regulation All work .hall tv d<• in %tni t <br />'I mrillantc wqh all Citt ordtnark: , huiklirtg u,tlr+ and, or health <br />tk-Mrtmtnt ngukttuxt,. and .hall lv a*gmt it, tmpnvon. apprmal or <br />relmlion ht the Co Whrrv,rr v, ordertd. the urdermped agrtxN to <br />oureo am w,wk fount to tv in %liblio n o(1hc condmom o(thn ptrmtt <br />Signature of Applicim <br />' "�C `fir t /��l��i' �`•- S�r,�`' <br />❑ AD[ <br />)ITION ❑ REPAIR <br />Water Well <br />Mechanical Equipment <br />Fireplace/ Wood Stove <br />Moving/Lifting Buildings <br />Land Alteration (Excavation. <br />Grading. Filling, etc.) <br />Design Review <br />Fire <br />Sprinkler System (Fire) <br />Other. <br />After -the -fact Investigation <br />O REMODELS <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />TOTAL. <br />State Surcharge: Fee $ <br />Total Amount Paid to Citv Fee S - L <br />This permit is not valid until the proper fee is paid and it i< approved <br />by an atltM)ri7Ld City Official. <br />Signatur ,4 City Ofihrhal <br />Calk: While- File Cttpy Cann InsMim'c Copy Pink hnanur Copy rk4d Applicant', Recttpl <br />