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GENERAL PERMIT <br />CITY OF ORONO <br />P.O. BOX 66 <br />CRYSTAL BAY. MINNESOTA 55323 <br />(612)47.3-7357 <br />Owner 6 JAW <br />Contractor <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT Tl PF. AND FEE: NEW <br />Inside Plumbing otfixturo, ____1 Fee S <br />Water Meter (Siic - -_ ) Fee S — <br />('11"i PFR%1lT N° 8857 <br />Date _ � • �' �' <br />�a15 <br />C-71 -7 ; 7 ,rir <br />Addlecc t_ /31 -OU -1A.1 lI <br />Address <br />City <br />O ADDrION ❑ REPAIR <br />Marrn ----------- -------_ <br />__.. <br />Remote +t -- ---- --- <br />Municipal Water Connection <br />Fee <br />❑ Copper O <br />Municipal Sewer Connection <br />I -Le S <br />❑ PVC ❑ Cast ❑ <br />MWCC SAC Charge <br />Fee S <br />On Site Spetic System <br />Fee $ <br />the undcragtnnl hrreh, ackntnvtnly% ntnpt .4 Thr, hrnneJ r%,imt. <br />nwmuding wrplar-e d all %Met Ink•rmttron, term,. uxtdrutrn, ra <br />reytrrrmema An atkyr. The urakivitrwtl undmutands and agree <br />under pr h t4 law that this permit is vrwdt limited in worr h, the wink. <br />attnns iw tmrxrnertwrtl 4wified: that thi% rx•rmn tkw+ my itranl am <br />atulwxitq ut tkr wink tx alYl.iuet reyunng w ryt ra x' permit apprtwak: anti <br />Oat this prtmMdor+,rungrandaudutntta,txdatramprovewntian;. iii <br />exdinence tw Slate VN ntk (v n1tutatum All r.rwk tiaU tw ekxte in arw i <br />ciwnplrame with all (lt} .edtrt mx%. huOJwg oxla and'ty health <br />derwnwnt rrgulaumx„, and 4*11 hr ruhKtt to tmpn-tion, aripmal .n <br />n7n-thm ht the 011 whene,rr v).ndrted. the undrrvgned aper ni <br />irwnCt am w ink knead u, he In tt. Jau0rat ti the t ,xxhtitmK r 4 thrt permtl <br />Water Well <br />Mechanical Equipment <br />Fireplace/WoM Sto%e <br />Moving/Lifting Buildings <br />Land Alteration (Excavation. <br />(irading. Filling. etc.) <br />lk-,ign Review <br />Fire --- - ----- - <br />Sprinkler Svstem (Fire) <br />Other - -- ----- <br />after-the-fart Im ,tigation <br />TOTAL <br />State Surcharge: <br />-16tal Amount Ixticd to City <br />❑ REMODEL <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S --_. <br />Fee S <br />Fee S <br />Fee S <br />Fee $ <br />Fee S <br />'M% permit is not Vallis until the projm fee is paid:lld it i%approved <br />by an authorized City Oficial. <br />Sill&lurc of Applicant <br />SiFnat of CitV Official <br />C'etde whits Fite Cop% Ca:un Inv. fti K s Coln INA- t=irawr CWty Gold- Applicants Reodpt <br />