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GENERAL PERMIT CITY PERMIT N� 8 6'7 3 <br /> CITY OF ORONO <br /> P.O. BOX 66 Date � �'`� <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner d ` a` Address `�� �� � / /'�-S1'l • <br /> Contractor �.�T�-Y1�a�r/ '�" �- Address i � ! �lJ � ,'I /`� <br /> City License No. �'� City <br /> REMARKS AND SPECIAL CONDITIONS <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/Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ Land Alteration (Excavation, <br /> ❑ Copper ❑ Grading Filling, etc.) Fee $ <br /> Design Review Fee $ <br /> Municipal Sewer Connection Fee $ <br /> Fire Fee $ <br /> ❑ PVC ❑ Cast ❑ <br /> MWCC SAC Charge Fee $ Sprinkler Sys m (Fire� Fee $ <br /> Other: `-1-C -.�Ly�---- Fee $ � �s� <br /> On Site Spetic System Fee $ <br /> After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> State Surcharge: Fee $ � �� <br /> The undersigned hereb�� acknowledges receipt of this limited permit, ��� (J'Z) <br /> including acceptance of all special information, terms, conditions or Total Amount Paid to City Fee $ <br /> reywrements written above. The undersigned understands and agrees <br /> under penalty of law[ha[this permit is stricdy limited in scope to the work, <br /> activiry or improvement specified;that this permit does not grant any <br /> authority todo work orac[ivities requiring zparate permitapprovals;and <br /> that this permit does notgrant authority to violate any provision ofany City <br /> ordinance or State law.rule or regulation.Au work shali be done in strict This permit is not valid until the proper fee is paid and it is approved <br /> compliance with all City ordinances, building codes and/or health <br /> department regulations,and shall be subject[o inspection,approval or by an authorized City Offieial. <br /> rejection by the City. Whenever so ordered,the undersigned agrees to <br /> correct any w�ork found ro be in violation of the conditions of this permit. <br /> Signature of Applicant <br /> Signatur of City Ofticial <br /> � � � ,� i� �-��� <br /> Codr. Whitc—File Copy Canary Inspector's Copy Pink—Finance Copy Gold—ApplicanPs Receipt <br />