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GENERAL PERMIT CITYPERMITNO. �962 ' <br /> CITY OF ORONO � _�� � �-- <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner ��'"3'< < )l=�t"�-l.Z-��� Address S L/ <br /> � � <br /> Contractor �.�/�'!-'1�,�, Address �� � :� <br /> � , <br /> City License No. � j� � State License No. C <br /> REMARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: NEW ❑ �YDDITION ❑ REPAIR <br /> Inside Plumbing (#fixtures_) Fee $ Water Well Fee $ <br /> Water Meter(Size_) Fee $ Mechanical Equipment Fee $�-,�c,� <br /> Meter# <br /> Remote# Moving /Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ _ Land Alteration (Excavation, Fee $ <br /> � Grading, Filling, etc.) <br /> ❑Copper <br /> Muilicipal Sewer Connection Fee $ <br /> Fire Fee $ <br /> ❑ PVC ❑Cast n Sprinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $ Other: Fee $ <br /> On Site Septic System Fee $ After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> The undersigned hereby acknowledges receipt of this limited <br /> permit, including acceptance of all special information, � <br /> terms, conditions or requirements written above. The <br /> undersigned understands and agrees under penalty of law State Surcharge: Fee $ �� <br /> that this permit is strictly limited in scope to the work, <br /> activity or improvement specified; that this perxnit does ��/ �/1 <br /> not grant any authority to do woxk or activities requiring Total Amount Paid to City Fee $ ��� <br /> sepazate permit approvals; and that this permit does not <br /> �ant authority to violate any provision of any City <br /> ordinance or State law,rule or regulation, All work shall be <br /> done in strict complience with all City ordinances,building <br /> codes and/or he�r� depaxtment regulations, �a �nau be This permit is not valid until the proper fee is paid and <br /> subiect to inspection, approval or reiection bY the c�cY. it is approved by an authorized City Official. <br /> Whenever so ordered, the undersigned a�ees to correct <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Signa e of Applicant Signature of ity Official <br /> � ' _.,�, - � � ;e..� <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />