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GENERAL PERMIT CITY PERMIT NO. <br /> CITY OF ORONO <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7 57 <br /> Owner Address L� <br /> Contractor Address 4 � G �I 04-AL <br /> City License No. l �[� State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: )§-NW ❑ ADDITION ❑ REPAIR <br /> Inside Plumbing( # fixtures ) Fee $ On Site Septic System Fee $ <br /> Water Meter (Size ) Fee $ Water Well Fee $ 39 <br /> Meter # <br /> Remote# Mechanical Equipment Fee $ <br /> Municipal Water Connection Fee $ Moving/Lifting Buildings Fee $ <br /> ❑Copper ❑ Land Alteration (Excavation, Fee $ <br /> Grading, Filling, etc.) <br /> Municipal Sewer Connection Fee $ <br /> ❑ PVC ❑ Cast ❑ Other: Fee $ <br /> MWCC SAC Charge 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 v <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 $-30 . <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 and <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 Applicant Sig a e�ofCity�OOffici f �( <br /> P <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />