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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 L)t iri n • S <br />Contractor 6fli 4'-N4 <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: NFW <br />Inside Plumbing (#fixtures_) Fee S <br />CITY PERMIT NO. 8502 <br />�)- <br />Date <br />< n <br />Address /I /Y') 011.r /'fid '5o - <br />Address A;306 Gq1 ajilliftrig <br />❑ ADDITION <br />Water Meter (Size—) Fee S —_ <br />Meter# <br />Remote # <br />Municipal Water Connection Fee S — <br />❑Copper n <br />Municipal Sewer Connection Fee S _-- <br />❑ Pw ❑ cast r-1- <br />MWCC SAC Charge <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />Fee S_ _-- <br />Fee S <br />The undersigned hereby acknowledges receipt of this Whited <br />permit, including acceptance of ad special information, <br />terms, conditions or requirements written above. The <br />undersigned understands and apses under penalty of law <br />t!at this permit is strictly limited in scope to the work. <br />activity or, improvement specified; that this Permit time <br />not pant my authority to do work or activities requhing <br />"pante Permit apprrwW: and that this Permit doer not <br />pant authority to violate my prorldon of my City <br />ordinance or State law, rule or regulation. Ali work shall be <br />done in street compliance with as city ordiame". budding <br />codes and/or health department regulations, and sball be <br />subject to inspection, approval or rejection by the City. <br />Whenever an ordered. the undersigned agrees to correct <br />my work found to be in violation of the conditions of <br />this perm". <br />Signature of Applicant <br />State License No. <br />❑ REPAIR <br />ater Well <br />anical Equipment <br />oving /Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />nkler System (Fire) <br />iter -the -fact Investigation <br />Nicoll n;11 <br />State Surcharge: <br />Total Amount Paid to City <br />Fre <br />S <br />Fee <br />S <br />Fee <br />$ <br />Fee <br />S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fees p11,12) <br />Fee u. � <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City Official <br />Cade: WhiteFileCopy Canary - Inspector's COPY Pink -Finance Copy Gold- Applicant's Receipt <br />