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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. 8403' <br />Dateg�l1 S6 <br />Owner Pe—rig Address, /5 � TeL <br />Contractor r Address �5C.� 7 ' l Or a• <br />City License No. l Q State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE <br />Inside Plumbing Oftxtures_) <br />❑ NEW ❑ ADDITION <br />Fee S <br />Water Meter (Size _) Fee S <br />Meter# <br />Remote # <br />!7 tf�l_, U <br />❑ REPAIR <br />ater Well <br />echanical Equipment <br />oving /Lifting Buildings <br />Fee S <br />Fee S <br />Fee $ <br />Municipal Water Connection Fee S Land Alteration (Excavation, Fee S <br />❑Copper Q Grading, Filling, etc.) <br />Municipal Sewer Connection Fee S — <br />Fire Fee S <br />❑ PVC ❑ Cast Q <br />MWCC SAC Charge Fee S <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />kler System (Fire) <br />r: <br />Fee S After -the -fact Investigation <br />Ttie undersigned kereby ackno+ladyn rec- t of"llsaited <br />permit, Including acceptance or all special lafornallon, <br />tertaa, conditions or requtnmenU .dtlaa above. 71s <br />undantlgned undars—do and apeee uadar Naalty of la. <br />that L W peranit la strictly llmllsd in KOM to 161e wart, <br />activity at tmprowmmt spacln*d; that " permit dons <br />not grant anyauthority to do work or aelmdas requiring <br />separate permit approvals: and that lW gemil does not <br />grant authority to violate any /rovidon o1 soy Clly <br />ordinance or Stale las, rule or regulation. All work 16x11 be <br />don* In strict compilaoce .Iib all City ordlaaam.6Wld+y <br />Codas and/or health departmeat regulations. area l6all a <br />subject Lo inspection, approval or rejection by t6a (:lty. <br />Whaaever m ordered. the underaipaed apeae ' too <br />any work found to be In •iolatlon of the con.tlticess of <br />this permit. <br />Signature Applicant <br />TOTAL <br />Fee S <br />Fee S <br />Fee S <br />State Surcharge: Fee S 1ST <br />Total Amount Paid to City Fee S 3G__56 <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City Off ' 1 <br />Code: White - File Copy Canary–tntpector't Copy rink–Finance Copy Gold –Applkant'a Receipt <br />