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GENERAL PERMIT
<br />CITY OF ORONO
<br />P.O. BOX 66
<br />CRYSTAL BAY. MINNESOTA 55323
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<br />(61-211473-7357
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<br />Contractor _ -Q -; > %/ �!1 S '/ C�
<br />Cit% I .icenK No. __ n !� • it
<br />RFMARKS /AND SPECIAL CONDITIONS
<br />_ `
<br />IF
<br />PERMIT TYPF AND FEE
<br />Inside Plumbing Oftxturo%
<br />Water Meter (Sm —►
<br />Meter a
<br />Remote u _
<br />Municipal Water Connection
<br />❑ Copper ❑
<br />Municipal Sewer C'onntmion
<br />❑ PVC ❑ Cast ❑ —.
<br />MWCCSAC Charge
<br />On Site Spetic System
<br />ACKNOWLECX&MFN'f
<br />IX NE W
<br />Fee S _---
<br />Fee S
<br />Fe's S
<br />Fee $ _. _-
<br />Fee S
<br />Fee S
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<br />SIP M Applicant
<br />Calk. Whttr 1 tte 01% Uanar, Immim'r ('ttpot
<br />( I I N Irl ►l%ll l N° 8940
<br />I}ate _ - is y'1
<br />Addresser l5`o L 1-4 11 1") .b r
<br />Address J . /I KO -1
<br />/ 70
<br />city _ Zt /0- •7 v
<br />IITION ❑ REPAIR
<br />Water Well
<br />Mechanical Equipment
<br />Fireplace/ Wood Stove
<br />Moving/Lifting Buildings
<br />Land Alteration (Excavation,
<br />Grading. filling, etc.)
<br />Design Review
<br />Fire
<br />Sprinkler System (Fire)
<br />Other. --- - --- ------ ..
<br />After -the -fact Investigation
<br />❑ REMODEL
<br />Fee $
<br />Fee S
<br />Fee S
<br />Fee S
<br />Fee S
<br />Fre S
<br />Fee S
<br />Fee S
<br />__-- Fee S
<br />Fee S - t'^ Z_ 00
<br />TOTAL _
<br />State Surcharge: Fee S
<br />so,) c-
<br />10tal Amount Paid to City Fee
<br />CPO// 7y
<br />-1 hit, permit is not valid until the pn►per fee is paid and it is appro%ed
<br />h, an authorised City Oficial.
<br />Signature ( C'Ity
<br />---- j i
<br />Pink Fromm• Copy
<br />Gnld- Appbum'% 16"p
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