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GENERAL PERI�IIIT CITYPERMITNO. 7ss� � <br /> CITY OF ORONO _ <br /> P.O.BOX 66 Date � ���� <br /> CRYSTAL BAY,MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner Address �f'1G�%�(� �GLt� �� <br /> Contractor �!'� .� ��SO'��Address <br /> City License No. /' �-�/� Y� State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> d'')Q.� �p ir �"vt�,�^^.o --- ��Q�� �Y <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION �REPAIR <br /> Inside Plumbing (#fixtures_) Fee $ Water Well Fee $ <br /> Water Meter(Size_) Fee $ Mechanical Equipment Fee $ <br /> Meter# <br /> Remote# Moving/Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ Land Alteration (Excavation, Fee $ <br /> � Grading, Filling, etc.) <br /> ❑Copper <br /> Municipal Sewer Connection Fee $. <br /> Fire Fee $ <br /> ❑ PVC ❑Cast Q Sprinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $ Other: . Fee $ <br /> On Site Septic System Fee $ ��� p0 After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> The undersianed hereby acknowledges xeceipt of this limited <br /> permit, including acceDtence of all aDedal information, � <br /> terms, conditions or requirements wxitten above. The State Surcharge: Fee $ +' <br /> undersigned underatands and a�rees under penalty of law <br /> that this permit is atrlctly limited in ecope to the work, <br /> activity or improvement speciHed; that this permit dcea �^�� <br /> not �rant any authority to do wosk or activities requiring Total Amount Paid to City Fee $ -�� <br /> seDarate Permit approvais; and that thie permit does not <br /> grant authority to violate any providon of any City <br /> ordinance or State law,rule or regulation.All work shall be <br /> done in strict complience with all City ordiaancea,building <br /> codes and/or health deDartment regulattons, and shall be 'I'his permit is not valid until the proper fee is paid and <br /> subject to inaDectton, apDroval or reiection by the City. <br /> Whenever so oxdered, fhe underaigned aa�rreea to coaect it is approved by an authorized City Official. <br /> any work found to be in violatlon of the conditiona of <br /> this permit. _ <br /> Signatu of Applicant Signature City Offici <br /> ��j(_, <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—ApplicanYs Receipt <br />