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GENERAL PERMIT <br />CITY PERMIT NO. 8496 <br />CITY OF ORONO <br />P.O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner — ]CYc e :ZDo Address /__73 /<7.1) '_ lClZe�Y� /�1-D <br />Contractor Address <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION <br />Inside Plumbing Qfixtures_) <br />Water Meter (Size—) <br />Meter# <br />Remote <br />Fee S <br />Fee S <br />Municipal Water Connection Fee S _ <br />❑Copper ❑ <br />Municipal Sewer Connection Fee S _ <br />❑ PVC ❑ Cast <br />MWCC SAC Charge Fee S _ <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />Fee S <br />The undersigned hereby acknowledges receipt of" 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 <br />that this permit is strictly limited in scope to the work. <br />activity or knprorement specified: that this parsnit don <br />not grant any authority to do work or activities requtrhy <br />"Parsee permit approval: and that this Parrott don not <br />grant authority to violate my provision of my city <br />ordinance or State law. rule or regulation. All work sbaa be <br />time in strict compliance with all City ordinances. budding <br />codes and/or health department regulations, and sbsa be <br />subleet to Inspection. approval or rejection by the City. <br />Whenever so ordered. the undersigned ages to correct <br />MY fork found to be in violation of the conditions of <br />this Petrels. <br />Signature of Applicant <br />Code. %hire File Copy Canary -Inspector's Copy <br />State License No. <br />❑ REPAIR <br />ter Well <br />anical Equipment <br />/Lifting Buildings <br />ind Alteration (Excavation. <br />Grading, Filling, etc.) <br />rinkler System (Fire) <br />Investigation <br />TOTAL <br />Fee S <br />Fee S <br />Fee $ 1 <br />Fee $ <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />State Surcharge: Fee S <br />Total Amount Paid to City Fee S-V� <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signet of City Icial , <br />Gold -Applicant's Receipt <br />