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GENERAL PERMIT CITY PERMIT NO. 8547 <br />CITY OF ORONO <br />P.O.BOY 66 Date <br />CRYSTAL BAY. MINNESOTA 5-5323 <br />(f6�12) 473-737 <br />Own_r. <br />P <br />1✓� Address —RU-) <br />Contractor t.t t ✓<t h /� J �'✓ ✓� C C' ; Address <br />City Uccnse No. �U 1C' State License No. <br />REMARKS AND SPI: CIA ISIDN DITIONS <br />ACKNOWLEDGEMENT <br />The undemgnrd hereby acknowledges receipt of this limited <br />permit. Including arceptai.ce of d1 spedd information. <br />terms, conditions or requirements written abme. The <br />undersigned understands and spires under penalty of law <br />that this permit Is strictly limited In scope to the work. <br />activity or Irriproyement specified; that this permit dues <br />not pant say authuntw to do work or scustues requiring <br />separate permit approvals: and that this permit don not <br />pant authority to sloute any proytsion of any City <br />urdinsnre of Slate law, rule or regulation. All work shall be <br />dune In strict compliance with as City ordinances, budding <br />codes and/nr health department regulations, and shall be <br />mbiect to Inspeetion. approval or reieetion by the City. <br />Wheneser. sit ordered, the undersigned agree to correct <br />any work found to b► In stolatiun of the cunditions of <br />this permit. <br />Sign (UR Of pplican <br />TOTAL <br />State Surcharge: Fee S --P -S-Z) <br />Total Amount Paid to City Fee S_.1. - <br />LP <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City Official _ <br />C'odcNldte - I He Copy Canny Inw"Itil'sCopy t'Ink- IinanceCopy Gold-Applkani);ftc pt . <br />PERMIT TYPU AND Fl+: <br />NI:W <br />❑ ADDITION ❑ REPAIR <br />Inside Plumbing Wixtures_ I <br />Fee <br />Water Well <br />Fee S <br />Water Meter (Si/e <br />Fee <br />Mechanical Equipment <br />Fee S <br />!Neter N <br />Remote <br />Moving /Lifting Buildings <br />Fee S <br />Municipal Water Connection <br />Nee <br />S_.____ _.� <br />Lance Alteration (Excavation. <br />Fee S <br />❑Copper ❑ <br />Grading. Filling, etc.) <br />Municipal Sewer Connection <br />Ice <br />S . - ---- _ <br />Fire <br />Fee S <br />❑ PVC' ❑ (.t,t <br />�- <br />Sprinkler System (Fire) <br />Fee S <br />MN'CC' SAC Charge <br />F=ee <br />S _ _.._ _.. _ <br />then: <br />Fee S <br />On Site Septic Sysent <br />1-ce <br />S 25' <br />After -the -fact Investigation <br />Fee S <br />ACKNOWLEDGEMENT <br />The undemgnrd hereby acknowledges receipt of this limited <br />permit. Including arceptai.ce of d1 spedd information. <br />terms, conditions or requirements written abme. The <br />undersigned understands and spires under penalty of law <br />that this permit Is strictly limited In scope to the work. <br />activity or Irriproyement specified; that this permit dues <br />not pant say authuntw to do work or scustues requiring <br />separate permit approvals: and that this permit don not <br />pant authority to sloute any proytsion of any City <br />urdinsnre of Slate law, rule or regulation. All work shall be <br />dune In strict compliance with as City ordinances, budding <br />codes and/nr health department regulations, and shall be <br />mbiect to Inspeetion. approval or reieetion by the City. <br />Wheneser. sit ordered, the undersigned agree to correct <br />any work found to b► In stolatiun of the cunditions of <br />this permit. <br />Sign (UR Of pplican <br />TOTAL <br />State Surcharge: Fee S --P -S-Z) <br />Total Amount Paid to City Fee S_.1. - <br />LP <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City Official _ <br />C'odcNldte - I He Copy Canny Inw"Itil'sCopy t'Ink- IinanceCopy Gold-Applkani);ftc pt . <br />