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GENERAL PERMIT <br />CITY OF ORONO <br />CITY PERMIT NO. ~ 6767 <br />Owner. <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)47p357 <br />Date. <br />Ta /jyfiO , <br />Contractor /I//tG^^AArvv^ ^‘^^0 Z^l)// Xi!2. //I <br />(jyK^ 0/i64^y=^/o Address. <br />City License No..State License No. <br />01MARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: <br />Inside Plumbing ( # fixtures. <br />Water Meter (Size__J <br />NEW □ ADDITION □ REPAIR <br />)Fee $. <br />Fee $. <br />Meter #_ <br />^ Remote # <br />Municipal Water Connection <br />Q Copper Q____ <br />Fee $, <br />Municipal Sewer Connection ^ <br />□ PVC □ Cast □__! <br />Fee $. <br />MWee SAC Charge Fee $. <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee S_________ <br />Fee <br />Fee $_________ <br />Fee S_________ <br />Fee $_________ <br />Other:, <br />After-the-fact Investigation ''W <br />Fee S. <br />Fee S V <br />ACKNOWLEDGEMENT <br />Tti« undenigntd hertby acliiiowtedtii ttctipl of Ihli UmlUd <br />pcimlt« includini acccpUncc of all 9tcial lofoimatloii, <br />taems, conditions or rcquiftmtnto wsitten abovt. Hit <br />undtrMgntd undantands and apitta under ptnalty of law <br />that this permit is strictly limited in aeope to the work* <br />activity or improvement specdBcd; that this permit does <br />not irant any authority to do work or activities requiring <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. AH work shall be <br />done in strict compliance with all City ordinancea. building <br />codes and/or health department regulations, end shaU be <br />subiect 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 the conditions of <br />this permit. <br />Signatiirc^LAikpli-^Ix.ilieant <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S. <br />Fee <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signatu:MTCity Official/^ <br />/-y <br />Code: White-rUc Copy Cinary - Inspector*! Copy Pink-llnancc Copy Gold-Applicant’s Receipt