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GENERAL PERMIT <br />CITY OF ORONO <br />CITY PERMIT NO.7992 <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)473-73? 7 <br />Date <br />Owner <br />Contractor <br />Address <br />City License No.-it- tSio-r.9 <br />Address ^ \ 0 f (~^Ji <br />State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />i <br />^ ^ ypoo ~~ / s o nviAj <br />hiCf'^x'f Xliytr-k (^oa^^-lrk b£.Q - <br />PERMIT TYPE AND FEE: “^NEW □ ADDITION □ REPAIR <br />Inside Plumbing, (#fixtures <br />-)Water Meter (Size <br />Meter#___ <br />Fee S <br />Fee S <br />Water Well <br />.^Mechanical Equipment <br />Remote #, <br />Municipal Water Connection <br />D Copper n <br />Municipal Sewer Connection <br />□ PVC □ Cast <br />MWee SAC Charge <br />On Site Septic System <br />Movina^iftin^Buildings^^ <br />d Alteratji^ (ExcayaAon, <br />Fee $ <br />Fee $ <br />Fee S <br />Fee $ <br />Sprinkler S)^^m (Fi <br />Other: <br />After-the-fact Investigation <br />ACKNOWLEDGEMENT <br />Tht uiMtoralcned hereby acknowltdiM rMttpt of tlU« Uiallod <br />pomit, deluding acotptiMict of iO tafomigllofi, <br />toimB, condllloiit or io«ulmiii«kU wdUon abovt. Tbo <br />undonignod imdtnteiidB aad aipMt itadar panalty of law <br />liiat Ibis parmit la ttrictty llmltad In aeopa to Iba woik. <br />activity or bnprovamaiit 9aciflad: IlMt UMb pacnlt doac <br />pot grant any audioilty to do worii or activltiaa rapiilaipg <br />•aparaU parmit approvals; and that this pamait doaa not <br />pant authority to violate any provtelQn of any City <br />ocdinanca or State law, rula or raguiatton. All woch diall ba <br />dona in atrict eompUanca with all City ordinanoaa, building <br />codaa and/or haallh dapartmant rapulahona. and ahdi ba <br />aublact to Inapaetlon, approval or lalaatlon by lha aty. <br />Whanavar to ordarad, Pte undaralgnad agteM to eoaraat <br />any worb found to ba in violation of lha eondIPona of <br />Ihia paimit. <br />Signature Applicant m / <br />'ll: <br />i <br />TOTAL M >: . <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S <br />'i <br />Fee i '7^- ^ <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signatiye of City (^icial <br />( oda Utiitc I Ua Copy Canary ~hiapoctof*s Copy Ptnl-Flllaiicc Copy Gold- AppMcgnt*! Mcoipt