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i <br /> GENERAL PERMIT � ��P�� N� s 7 5 s <br /> �;IT"Y OF ORONO <br /> � ` l� -a - <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY,MINNESOTA 55323 . <br /> (612)473-7357 - <br /> Owner �I.c,) i �'1 __1(�1�� QS Address I'�l��=h or.� 1 ��f1 Z. �'Ir <br /> Contractor � Address ���Y f"1" 7"-e/ .DY: <br /> Clt}+J 10EC1SC N0. /`'' Clty .�/ n r%Y'� <br /> REMARKS AND SPECIAL CONDTTIONS <br /> PERMIT TYPE AND FEE:� � NEW O ADDTI'ION ❑ REPAIR ❑ REMODEL <br /> Inside Plumbing(#fixtures�) Fee $ �� Water Well Fee $ <br /> Water Meter(Size ) Fee $ MechanicaZ Equipment Fee. � <br /> Meter# Fireplace/Wood Stove Fee $ <br /> Remote# Moving/Iafting Buildings Fee $ <br /> Municipal Water Connection Fee $ Land Alteration(Fxcavation, <br /> ❑ Copper O Grading,Fillint8,etc.) Fee $ <br /> Design Review Fee $ <br /> Municipal Sewer Connection Fee $ Fire Fee $ <br /> 0 PVC ❑ Cast ❑ <br /> Sprinkler System(Fire) ,� Fee S <br /> MWCC SAC Charge �� $ Other. ��''� Fee $ '� <br /> On Site Spetic System Fee $ <br /> After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> State Surcharge: Fee $ • �� <br /> 'Ihe undersigned hereby acknowledges receipt of this limited permit, <br /> i�luding a�ptance of all special infom�aUon, terms, conditions � Total Amount Paid to City Fee $ � <br /> reqwrements written above. The uhdersigned underslands and agrees <br /> under penalty of law that this permit is strictly limited in scope to the work, � ��, O O <br /> activity or improvement specified;that this pertnit dces not grnnt any ����� <br /> suthority W do work or activities requiring separate permit approvais;and <br /> ttiat this pertnit dces not grant suthority to vidate any provision dany City <br /> ordinance or State Iaw,rule or regulaoon.All work shall be done in strict '�permit is not valid unt�the proper fee is paid and it is apgroved <br /> �mdiance with all City ordirmnms, bm7di� code.s and/or healdi b AII all�lOt1ZC(�Cl �Cl�. <br /> department►egulations,and shall be subject to inspection,approval or y ty <br /> rejection by the City.Whenever so ordered,the undersigned agrecs to <br /> correct any work found to be in violation of the wndioons of this permit. <br /> Signature of Applicant <br /> _ ' Signature City O�cial <br /> ��� <br /> Code: White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />