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<br /> : -• GENERAL PERMIT CITY PERMIT NO. I
<br /> "-todi
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<br /> 'CITY OF ORONO
<br /> Date
<br /> P 0.BOX 66 •
<br /> ':,'•'' ' CRYSTAL BAY,MINNESOTA 55323
<br /> (612)4734357
<br /> .... -
<br /> ' O CeetUD 0/1CC
<br /> Owner Address 5c-A0 OP-ono 412c44L) • ,ii,-.1 ,'
<br /> 1112,4v,14.0., vv..Isc.,,
<br /> Address inbUilri &Al
<br /> Contractor ...
<br /> l' 19' '',,, l' I , ••'„'City License No. State License No.
<br /> ,Y ,,e•
<br /> REMARKS AND SPECIAL CONDITIONS
<br /> . ,. . • , .,
<br /> k•2 7-#..;.• ' ,
<br /> t: • • c...; (,•-• -•,
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<br /> — .
<br /> PERMIT TYPE AND FEE: 0 NEW 0 ADDITION 0 REPAIR
<br /> • tj,:: •.-;.s,• , -- ., -
<br /> :4
<br /> Inside Plumbing(# fixtures_) Fee S On Site Septic System Fee $..---
<br /> '•.' :.'•,,,•; . • „.
<br /> ',,'•'-
<br /> ' • + WaterMeter(Size—) Fe $ Water Well Fee $---
<br /> te M i '
<br /> e r Mechanical Equipment ' ... .
<br /> ReinFee S
<br /> ff
<br /> t Moving/Lifting Buildings Fee $
<br /> : Uhl' cip-Li Water Connection Fee $—. .1 ••
<br /> t, '••• , rn n
<br /> Lj Copper Land Alteration(Excavation,
<br /> Fee $.-- .
<br /> Grading,Filling,etc.) . .
<br /> 20 00
<br /> ,..;Municipal Sewer Connection Fee $ .
<br /> . . . .
<br /> ' '''''''%1 • PVC 0 Cast fl Other: Fee $ ,5
<br /> M.'.WCC SAC Charge Fee $ 4•125°° After-fix-fact Investigation Fee $
<br /> ,1 k
<br /> -
<br /> ejlig-,0q
<br /> ACKNOWLEDGEMENT TOTAL ,
<br /> - ' 'A:4`.4...,.•••• The undersigned hereby acknowledges:ergot of this limited 1
<br /> ail special information. .
<br /> "an".'Inehmuns Tr'Prolmotnt. ..itt.. &b.. The -S-0
<br /> tetras.,aolidholis itezais and atom under „nolo of fon State Surch;Jge: Fee S—.4.---_....
<br /> ,, ir_fr•-•' Underigill” Ur
<br /> 'thatis tly limited in scope to the work.
<br /> aetivito,or Improvement somdfiedt that this permit does( Fee $ -111/4r6a
<br /> ,,,noc pant any authorilr to do work or activities stI41
<br /> Total Amount Paid to City
<br /> do
<br /> '-•. ,•,,,,,t..,,,,-4,,,,..1•• JO iiiPalniodt,t,,IroplrOVvioiallitai and ythapet ovistothia 17 of any
<br /> any Cinot
<br /> en o
<br /> s i ',40. ,,,,,••grant
<br /> ', ' •-•, :`,'''..`.•:ordinance or State law.:vie Or regulation.All work. Assn be
<br /> II,., `, , 4'.•-,."•:•,„.1`'''.."'.done In strict comPliallee with in City atdlnsncesti ns and shall
<br /> codes andlor health department !tibia It • This permit is not valid until the proper fee is paid and
<br /> or mieedon the City.
<br /> isubject to inegmiich• oPPrbytoowli d wanes conwt it is approved by an authorized City Official.
<br /> ":: : '.,','wian7nrort‘sesouneIlka rr bet: violation of the conditions of
<br /> this permit.
<br /> , tul .. Signatu f City •4,1 40,1
<br /> silt' ature •plict
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<br /> ,,, ,,„r,o•-•
<br /> .: 1••,,,--,4‘ i-t: , Code:White-Re Copy Canary-Inspector's Copy Pink-I:bunco Copy Gold- pplicant's Receipt .. ,
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<br /> 'It I "tf; ".**.i 7,
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