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CITY PERMIT NO. 79741 <br /> GENERAL PERMIT <br /> CITY OF ORONODate <br /> P.O.BOX 66 <br /> CRYSTAL BAY,MINNESOTA 55323 <br /> (612)473-717 <br /> Owner D be_� LQA • Address <br /> Contractor Uato_ Address <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑REPAIR <br /> Inside Plumbing(#fix ires_) Fee $ Water Well Fee $ <br /> Water Meter(SiFee $/ Mechanical Equipment Fee $ <br /> Meter# g <br /> Remote# L- Moving /Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ Land Alteration (Excavation, Fee $ <br /> Grading, Filling, etc.) <br /> ❑Copper <br /> Municipal 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 $ _ <br /> 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 permit does <br /> not grant any authority to do work or activities requiring Total Amount Paid to City Fee $/ <br /> separate permit approvals; and that this permit does not <br /> grant authority to violate any provision of any City <br /> ordinance or State law,rule or regulation.All work shall be <br /> done in strict compliance with all City ordinances,building <br /> codes and/or health department regulations, and shall be This permit is not valid until the proper fee is paid an <br /> subject to inspection, approval or rejection by the City. it is approved by an authorized City Official. <br /> Whenever so ordered, the undersigned agrees to correct <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Signature of icant Si re of City <br /> l� <br /> Code: e e Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />