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GENERAL PERMIT CITY PERMIT NO. 8163 <br /> CITY OF ORONO <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> Owner - �1 Address 1LQC) <br /> Contractor Address <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR <br /> Inside Plumbing (#fixtures_.) Fee $ Water Well Fee $ <br /> Water Meter (Size—) Fee $ Mechanical Equipment Fee $ <br /> Meter# <br /> Remote# Moving /Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ Land Alteration (Excavation, Fee $ <br /> 1:1 Copper ElGrading, Filling, etc.) <br /> Municipal Sewer Connection Fee $ _ Fire Fee $ <br /> ❑ PVC ❑Cast n Sprinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $ Other: �� �ZI � Fee $ C <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 <br /> h <br /> activity orimprovem improvement specified that scope t <br /> 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 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 Signature of City Offici <br /> j <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy old—Applicant's Receipt <br />