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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)473-7357 <br />Owner <br />Contractor.Slfj/pn\ /jhJ! <br />City License No.. <br />RE.MARKS AND SPECIAL CONDITIONS <br />Address, <br />CITY PERMIT NO. __ 691 i • <br />Date <br />Atildur Park Rd. <br />Address ___________________ <br />State License No. <br />PERMIT TYPE AND FEE <br />Inside Plumbing (fixtures <br />Water Meter (Size____) <br />Meter If__________ <br />: ^NEW □ addition □ REPAIR <br />Fee S. <br />Fee S. <br />Remote # <br />Municipal Water Connection <br />□ copper □------ <br />Fee S_ <br />Municipal Sewer Connection <br />□ PVC □ Cast □. <br />Fee S. <br />MWee SAC Charge Fee S_ <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit. Including acceptance of cU special infonnatlon, <br />terms, conditions or requirements written above. The <br />underlugned understands and agrees under penalty of law <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 acUvlUcs requiring <br />separate permit approvals; and that this permit docs not <br />grant authority to \iolate any provision of any City <br />ordinance or State law, rule Or regulation. AU work shall be <br />done in strict compliance with all City ordinances, budding <br />codes and/or health department regulaUons, and shall be <br />subject to Inspection, approval or rejection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be in violation of tlie conditions of <br />this permit <br />Signaturee of^plicaiW <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Other:_ <br />After-the-fact Investigation <br />Foe S__________ <br />Fee S <br />Fee S__________ <br />Fee S--------------- <br />Fee S-------------- <br />Fee S_________ <br />Fee S ^D-^0 <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S..SO <br />Fee S ^o.so <br />This pennit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Sigtiatlire of City Off^iSh \ <br />j\h/wi/iA (1/ /^sj <br />Code: Wliitc-file Copy Canary-Inspcciur’s Copy Pink-l inance Copy Gold-Applicant’s Receipt