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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 />CITY PERMIT NO.784i <br />Dnt. 3-/3-^S~ <br />Owner Address Z'K&O y^iR,/AJC,x>Cif^ //HZ <br />Cnntrnrtnr C^M iCfCJUyJ^ ArcSAt<Ar7 _______ Address /^h' ^f=c7/t^______________________ <br />City License No-------------------------------------------------State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />_____________^ ~ /or^tD 'tx A/v Z/Ioc }2SZD ^ P/C^aJ^/c-z-^ <br />PERMIT TYPE AND FEE: ^]0[n EW □ ADDITION □ REPAIR <br />Inside Plumbing (^fixtures __) <br />Water Meter (Size__) <br />Meter#______________ <br />Remote #. <br />Municipal Water Connection <br />OCopper n <br />Municipal Sewer Connection <br />□ pVC DCast Q. <br />MWCC SAC Cliarge <br />On Site Septic System <br />Fee S <br />Fee S <br />Water Well Fee <br />Mechanical Equipment Fee <br />Moving /Lifting Buildings Fee <br />Land Alteration (Excavation, Fee <br />Grading, Filling, etc.) <br />Fire Fee <br />Fee I? <br />1 ec 0 <br />Fee .S <br />Sprinkler System (Fire) Fee <br />Other: Fee <br />After-the-fact Investigation FeeFee S '’7'^^ <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit* Including acceptance of all special information* <br />terms* conditions or requirements w'tittcn above. The <br />undersigned understands and agrees under penalty of law <br />that this permit is strictly limited in scope to the work* <br />activity or improvement specified: that this permit docs <br />not grant any authority to do work or activities requiring <br />separate permit approvals; and that this permit does not <br />grant authority to violate any pro\ision of any City <br />ordinance or State law* rule or regulation. All work ^all be <br />done in strict compliance with all City ordinances, building <br />codes and/or health department regulations* and shall be <br />subject to inspection* approval or rejection by the City. <br />Whenever so ordered* the undersigned agrees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Sigilpturc of Apt^jeant <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S. <br />Fee S.7-^ <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authonzed City Official. <br />Signature of City Official / <br />Code: Wliitc-rUc Copy Canaiy-Inspcctoi ’s Copy Pink-Finance Copy Gold-Applicant ’s Receipt