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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 />Conlractor.(L/M^ m// <br />City Uoensc No. <br />REMARKS AND SPECIAL CONDITIONS <br />Address. <br />Address. <br />City _ <br />CITY PERMIT N9 8649 <br />Dale <br />Pi i <br />V C> ^ <br />nr\ 9b- ^jL.po^ — ^ <br />PERMIT TYPE AND FEE <br />Inside Plumbing (^flxturcs__ <br />Water Meter (Size___) <br />Meter #__________ <br />>4NEW <br />Fee S <br />Fee $ <br />□ ADDITION □ REPAIR <br />Remote H <br />Municipal Witcr Connection <br />□ Copper □ ___ <br />Munidpal Sewer Connection <br />□ PVC □ Cast □ <br />MNS'CC SAC Charge <br />On Site Spctic S>'stcm <br />Fee S <br />Fee $ <br />Fee S_________ <br />Focs 2S^ <br />□ REMODEL <br />Water Well Fee $ <br />Mechanical Equipment Fee $ <br />Fircpiacc/Wood Stove Fee $ <br />Moving/Ufting Buildings Fee $ <br />Land Alteration (Excavation, <br />Grading, Filling, etc.)Fee S <br />Design Review Fee S <br />FiiB .. _ ..................Fm» « <br />Sprinkler System (Fire)Fee 5 <br />Orhor Fee $ <br />After-the-fact investigation Fee $ <br />ACKNOWLEDGEMENT <br />The underMpnol lieaby ackmmledges reaipl of this limited permit, <br />irKtuding aacpLincc of all sjxvial information, term^. corxJiliom or <br />a*quircmenis written ahme. The undenagned understands and aga‘cs <br />under penalty of law that this permit tssiricily limited in 5co|v to the work, <br />activity or improvement 5(vcified: that this permit docs not gram any <br />authority to dc» work or activities a'i|uiring separate permit approvals: anil <br />that this fvrmil dtx's not grant authority to viobte any piovisitm of any City <br />ordinarxx* or State bvv. rule or a*gubiion. All work shall be done in strict <br />compliance with nil City rrrdinances, building axles and/or health <br />department regubtions. anil shall be subject u» iRsjxxriion. approval or <br />rejection by the City. WTienewr stv ordered, the undersigned agrees to <br />cTrrnxt any work fouixl to be in vioblion of the a>nditions of this permit. <br />TOTAL <br />Slate Surcharge:Fee S <br />Signature of Applicant <br />(UJLQl\ <br />Total Amount l\iid to City Fee <br />This permit is not valid until the proper fee is paid and it is approved <br />by an authorized City Oflicial. <br />Signature c^ily Oflidal ^ a <br />-O- <br />Code-: White-nie Copy Canary—Inspcxior's Copy Pink—Rnanev Copy Gold—Applicant's Receipt