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� � GENERAL PERMIT CITY PERMI'T N� 8'7 8 6 <br /> CITY OF ORONO <br /> P.O. BOX 66 Date � � ^ '� � � <br /> CRYSTAL BAY,MINNFSOTA 55323 <br /> (612)473-7357 <br /> Owner ���t�U+.� I �'1 �G_ Z'_�[J S Address '��-� �f���YC� ,i ��C'_, _ ��''r. <br /> Contractor ���� � n �� �� . Address ���� ���-C/J� �G� �� <br /> City License No. ��� �l,� City �� ��+Q�e �C�-i dl <br /> REMARKS AND SPECIAL CONDITIONS <br /> 1I �� r� C7� n <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 /> ❑ Co r ❑ Grading, Filling, etc.) Fee $ <br /> p� Design Review Fee $ <br /> Municipal Sewer Connection Fee $ <br /> Fire Fee $ <br /> ❑ PVC ❑ Cast ❑ <br /> Sprinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $ <br /> � Other: Fee $ <br /> On Site Spetic System Fee $ ` � <br /> After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> State Surcharge: Fee $ <br /> . :a� <br /> The undersigned hereby acknowledges receipt of[his limited permit, C � <br /> including acceptance of all special information, tertns, conditions or Total Amount Paid to City Fee $ <br /> ���� ,�� <br /> reqwrements written above. The undersigned understands and agrees <br /> under penalty of law that this permit is stricUy limited in scope to the work, /� �� ,l� � �� <br /> activity or improvement specified; that Ihis permit dces not grant any �..�..'��� <br /> authority todo work or activides requiring separate permit approvals;and <br /> that this pertnit does notgrantauthority to violate any provision ofany City <br /> ordinance or State law,rule or regulation.All work shall be done in strict '1'his 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 to inspection,approval or by an authorized City Official. <br /> rejection by the City.Whenever�ordered,the undersigned agrees to <br /> correct any work found to be in�iclation of the conditions of this permit. <br /> Signa re Applicant <br /> ` Signature o City Official , <br /> � � <br /> Code: White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—ApplicanPs Receipt <br />