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1437 • 4 <br />ed, shall <br />I bdaw. <br />GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)473-7357 <br />Vril I 1 UULJJL <br />Date <br />Owner S <br />U/ ' Mvfc. <br />^________________________________City License No. <br />Address ^ 4/^ <br />Address In SO ! /l/X—LS_ <br />State License No------- <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: D NEW D ADDITION D REPAIR <br />Inside Plumbing ( # fixtures-----) <br />Water Meter (Size-^£) <br />Fee $On Site Septic System <br />Fee t -l^rQO Water Well <br />Meter » ?>Q ! 03 ^ — <br />Remote# J ^ 4"'1 L <br />Municip^Water Connection <br />Copper <br />Fee » Al}. (JO <br />Municipal Sewer Connection <br />□ PVC □ Cast Q <br />MWCC SAC Charge <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee $ <br />Fee * <br />Other:, <br />Fee $,After-the-fact Investigation <br />Fee $ <br />1 ee $ <br />ACKNOWLEDGEMENT <br />HcttvlSrorlmptov«m«nt ipecift«d; that this p«mlt doM <br />not gfM»t M»y •uthoiKy to do work or actlvltlM nauirlng <br />!Lparat« ponnlt opprovolr, and that tto <br />awit authortty to vloUte any ptovlMon of any <br />^^•nce or SUta law. rule or ragulatton J4U work <br />In atiict compUanea with aU City ordinancaa <br />.tSL milo. h»l«. <br />Mblact to Inapaclion. approval or ralaction by tha City. <br />Whanavar ao ordarad. tha undaralgnad agraaa to contact <br />any work found to ha In vlolatfon of tha condltlona of <br />Ihto ptimit <br />Signaturcjof Applicant ^ire^f Applicant ^ -yf <br />Ay <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee $, <br />Fee < ^ S.S0_ <br />This pennit 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 />Code White-l ilc Copy Cwary-Inspectoi ’lCopy Pink-Finance Copy Gold Applic«.fs Receipt