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GENERAL PERMIT <br />CITY OFORONO <br />po-BOX01 <br />(-RYSTAL BAY. b11K\ <br />Ihl_)a� <br />`l <br />Owner ------ <br />Contractor <br />Cit) License No. <br />RI -MARKS AND SPECIAL CONDITIONS <br />Pl'.RMIT TYPE AND FF.F <br />til N <br />hwde Plumbing 4Otixturrs-1 <br />cl Ty PI• RMnT No. <br />ti„II� <br />Date <br />Address <br />Address <br />Statt: License %0. <br />❑ ADDITION ❑ REPAIR <br />Fcc $ _ -—Iw'a1tr Well <br />Water deter ISice _-► <br />I•rr � <br />deter# <br />Remote <br />Municipal water Conn tion <br />❑(-Opper <br />Fee 5 <br />\lunicipal SCu <br />ewrr nnectinn <br />0 PVC- ❑ C-a.t [1_— <br />Fee 5 <br />\1WCC SAC charEe <br />On Site Septic SII stem <br />Mechanical Equipment <br />Sloving,'Lifting Buildings <br />Land Alteration (Excavation. <br />Grading. Filling. et" <br />Fee 5 -- <br />ACKNOWLEDGEMENT — <br />ACKNOWLEDGEMENT <br />The undentgn.d Manna .rinur Mdp• rrrgDl ul this limited <br />p.rmll. including .ccept•naa " f .y.dJ allorm.tlun. <br />tom., eundlunne w nqulnm.ny rntt.n .bo.e. Thr <br />done <br />und•d und.nt.uit and .gree. under pendia of �r <br />the I permit t ■talc dt Ilmltrd In .cope w the 'wk' <br />as tl.lt .0 bnprov.lhenl .p.clll.d, that WIs We""trin <br />n.d grant An%%.IrDrotJ•^ end 1h.t wV De rm It do.s not <br />want V Permit HnA.W .nV prottllun of .n• C•ltt <br />grant alhont /� <br />wdn.nct or tint• punt• rllb r&a l`It oordln.nce.. budding <br />dune M .trlct c.un Mian .nl r. tul.Uune..od .hall be <br />cud.. .ndlnr h.Jtb drDart-- .r r.1.Cuorn by the Cit. <br />eubMcl to b,rp.cum. sopr.r.J .d mall" to cone.' <br />Wb.ne• w .rd.red. the n✓' ul the eaedlUom of <br />.nr Iwnd W be <br />e Ilj <br />. 4of Ati_ . A, ttl t <br />6tuP <br />CC _ <br />irc <br />FeeS <br />---- <br />Fee <br />S <br />Fee <br />S- <br />-Fee <br />S <br />Fee <br />_ <br />Fee S <br />Sprinkler System IEirel T <br />fr <br />( Fee S ' <br />thea... <br />M7lire -I1k Cop) Canso - tn+pcctot-+iupl <br />I Investigation Fee 5 <br />101AL <br />Stair Surcharge: Fee S <br />Total Amount Paid to City Fee S <br />This permit is not valid until the proper fee is paid anc <br />it is approved by an authorized City Official. <br />Signature of City Oflj itd <br />pink I tn.n.e Cop) G0M-APPK=W%1rifP4 <br />