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GENERAL PERMIT ��P�� N� s s o z <br /> CITY OF ORONO <br /> P.O.BOX 66 Date / <br /> CRYSTAL BAY,MIlVNESOTA 55323 <br /> (612)47 -7357 <br /> Owner f'1 �O Address� �/���C�l�' � ` <br /> Contractor (/�,���il!'I'l PP^ p�� � -�/�� <br /> City License No. � Ciry <br /> REMARKS AND SPECIAL CONDTITONS <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR ❑ REMODEL <br /> Inside Plumbing(#fixtures ) Fee $ Water Well Fee $ <br /> Water Meter(Size ) Fee $ Mechanical Equipment Fee $ <br /> Meter# Fireplace/Wood Stove Fee $ <br /> Remote# Moving/Iafting Bu�dings Fee $ <br /> Municipal,Water Conn�tion Fee $ Land Alteration(Excava.tion, <br /> ❑ Copper ❑ Grading,F�ling,etc.) Fee $ <br /> Municipal Sewer Connection Fee $ �� •� Design Review Fee $ <br /> C�PVC ❑ Cast ❑ Fire Fee $ <br /> MWCC SAC Charge Fee $ .5.� Sprinkler System(Fire) Fe� $ <br /> Other. Fee $ <br /> On Site Spetic System Fee $ �._�e-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> State Surcharge: Fee $ � � <br /> The undersigned hereby acknowle�reteipt of this limited permit, �v���'� <br /> includ'uig acceptance of all spectial information, terms, conditions or TO�E�IIlOUIIt�d1C�t0 C1Ty FP.e $ <br /> requirements written above.The undersigned understands and agrees <br /> under penalty of law that this permit is shictly limited in scope to the work, <br /> activity or improvement specified;that this permit doe.s not giant any <br /> authority to do work or activiUes requiring sepa►a�permit approvaLs;and <br /> that this permit dces notgantauthority w violate any provision of any Ciry <br /> ordinance or Smte law,rule or regulation.All work shall be done in strict �pe�t is not valid unt�7 the proper fee is paid and it is approved <br /> compliance with all City ottlinances, bwlding codes and/or health <br /> department reguladons,and stiall be subject to insp�on,approval or by an authorized Ciry Official. <br /> � rejection by the Ciry.Whenever so ordered,the urttiersigned agre�.c to <br /> �correct any work found to be in viala�rin of the condilionc of this permit <br /> �e of Applicant <br /> � , Signa e of City Offcia. <br /> ,.z���!'`-��/' Gv/�.� � <br /> White—Fle Copy Canary—Inspector's Copy Pink—Finance Copy Gold—ApplicanPs Rec:eipt <br />